Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
What radiation doses and subsequent treatment monitoring would you recommend for multiple myeloma patients with multifocal bony lesions who decline chemotherapy?
Systemic therapy is the cornerstone of treatment for multiple myeloma, and the vast majority of patients initiate an appropriate regimen upon diagnosis. Occasionally, patients will have very limited disease and will be referred to Radiation Oncology for consideration of local therapy to delay the ne...
Would you use perioperative durvalumab in patients with diffuse-type gastric adenocarcinoma given no event-free survival benefit was seen for these patients in MATTERHORN?
Although MATTERHORN demonstrated a significant event-free survival benefit for perioperative durvalumab plus FLOT in the overall population, the forest plot does not show a clearly favorable signal in the diffuse-type subgroup. Because subgroup analyses are underpowered and not intended to confirm l...
How do you explain progression free survival to patients?
This is a really, really important question. I'd argue we often greatly undervalue the importance of communication with our patients and the impact the quality of our communication has on what they understand about their illness. I remember once having a long conversation with a patient where I outl...
How do you manage anemia associated with belzutifan therapy?
Anemia is a common toxicity with belzutifan. In a recent pooled safety analysis (Choueiri et al., The Oncologist KCRS Meeting 2024), anemia was seen in 84% of patients (any grade; 29% grade 3) with a median time to onset of 29 days. It is an on-target effect resulting from HIF regulation of erythrop...
How do you manage anemia associated with belzutifan therapy?
Anemia is a common toxicity with belzutifan. In a recent pooled safety analysis (Choueiri et al., The Oncologist KCRS Meeting 2024), anemia was seen in 84% of patients (any grade; 29% grade 3) with a median time to onset of 29 days. It is an on-target effect resulting from HIF regulation of erythrop...
Would you use adagrasib in combination with cetuximab for metastatic colon cancer with KRAS G12C mutation?
The NCCN guidelines were recently updated to include KRAS G12C inhibitors (adagrasib/sotorasib) in combination with anti-EGFR antibodies (cetuximab/panitumumab) for KRAS G12C mutant metastatic colorectal cancer. The majority of patients with this alteration obtain clinical benefit from this combinat...
How would you manage a patient with a solitary plasmacytoma with a partial response to RT?
A solitary osseous plasmacytoma can be higher or lower risk than an extra medullary plasmacytoma; for instance, a tonsillar plasmacytoma is different than one in lung parenchyma. The largest study I know about evaluating solitary plasmacytoma of the bone involved 206 patients without evidence of mye...
Which imaging modality do you prefer when monitoring disease status for patients with prostate cancer undergoing 177-Lu PSMA treatment?
At the present time, I generally use contrast-enhanced CT of the chest/abdomen/pelvis and whole-body Tc-bone scan (every 12 weeks) for monitoring. While it is attractive to consider serial PSMA-PET imaging for monitoring disease response to 177Lu-PSMA-617, there is currently no FDA indication to use...
For LS-SCLC with radiographic CR after chemotherapy, is there a time point beyond which you do not offer radiation if there is a delay in initiation of radiation?
I don't think we really have any data guiding this scenario. We know that optimal benefit is achieved when definitive RT is given within the first 2 cycles of chemo. However, I don't think that chemo alone is adequate for total eradication of disease. If the patient is within 1-2 mos of completing c...
How do you approach treatment of 1p19q non-codeleted high grade gliomas?
The question focuses on the management of 1p19q non-codeleted high-grade gliomas, which for all practical purposes translates roughly to the entity that by legacy terminology has been referred to as anaplastic astrocytoma. This question has come into focus with the recent publication of results of t...