Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Are there patients for whom CROSS followed by surgery and adjuvant nivolumab should still be considered, following data from MATTERHORN and ESOPEC?
ESOPEC does not invalidate CROSS—it redefines the preferred option for fit patients; in the real world, not every patient will be able to tolerate FLOT or d-FLOT: Yes. Despite the emergence of perioperative FLOT-based strategies from ESOPEC and MATTERHORN, CROSS, followed by surgery and adjuvant niv...
In the high-risk adjuvant or metastatic setting when you initiate patients on ovarian suppression with the plan to start an AI, what protocol do you follow in terms of rechecking estradiol?
This is an area of intense interest, as well as uncertainty. In truth, unless the patient does not have a uterus, (unusual in premenopause) I typically follow clinical menses and have not followed estradiol.
Would you consider using bevacizumab/atezolizumab in HCC patients who received TKI in the first line?
This is a great question. After failure of a front-line single agent TKI, I would still favor the current FDA-approved agents: regorafenib; cabozantinib; ramucirumab in AFP-high; OR immunotherapy (nivolumab, pembrolizumab, OR nivolumab plus ipilimumab). It is important to note that the second-line ...
What is your platelet cutoff for atezolizumab + bevacizumab in HCC in the absence of bleeding (variceal or otherwise)?
The platelet eligibility for IMBrave150 was 75K, I believe. Eligibility in the original SHARP trial was 60K, so I often consider somewhere around 60K. Although if truly no varices on EGD and no history of bleeding, I might consider down to 50K. Lower than that, I would probably think single agent ch...
Are there any biomarkers that might indicate who might be responders to atezolizumab/bevacizumab for HCC?
Not at this time. Some preliminary studies are being done as ad hoc at this point and was not pre specified before the IMbrave study launching
Would you offer adjuvant chemotherapy, or osimertinib if EGFR+, to patients with two synchronous stage 1A lung cancers that appear to be distinct and have both been resected?
Probably not. The cure rate for stage IA adenocarcinoma is 75-90%, depending on the details (including size). The ADAURA trial demonstrated a substantially improved DFS favoring osimertinib over placebo for patients with stage II or III NSCLC with an activating EGFR exon 19 or 21 mutation. Although ...
Would you offer adjuvant chemotherapy to a post menopausal woman with T1-T3 primary tumor with 4 positive axillary LNs and OncotypeDX score less than 15?
The recurrence score and other genomic assays have been clinically useful in predicting chemotherapy benefit in HR+, HER2-, lymph-node–negative breast cancer and more recently in women with 1-3 positive lymph-nodes (Kalinsky et al., PMID 34914339). At this time, there is no role for genomic assays w...
In a patient with high risk acute promyelocytic leukemia, when do you consider ATRA+ATO with GO vs ATRA+ATO with idarubicin?
Given the recent publications with ATRA/ATO and GO in high risk patients or low risk patients who develop leukocytosis (Blood 2017) and the long term follow up of the comparative study form the NCRI AML Working Group (Blood 2018), GO is my preference in all cases unless there is hepatic toxicity or ...
In a patient with high risk acute promyelocytic leukemia, when do you consider ATRA+ATO with GO vs ATRA+ATO with idarubicin?
Given the recent publications with ATRA/ATO and GO in high risk patients or low risk patients who develop leukocytosis (Blood 2017) and the long term follow up of the comparative study form the NCRI AML Working Group (Blood 2018), GO is my preference in all cases unless there is hepatic toxicity or ...
In NSCLC, would you manage other MET alterations, such as a MET T618T mutation, in the same way as a MET exon 14 skipping mutation?
It depends on the specific MET alteration. For example, nonsynonymous SNV mutations in the juxtamembrane region that affect the Cbl binding site, such as Y1003F, may exhibit oncogenic potential similar to exon 14 skipping mutations. However, synonymous mutations such as the one in question, T618T, m...