Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Is the PFS benefit sufficient to adopt up front acalabrutinib plus BR for all patients with MCL?
In my opinion, PFS is not sufficient to adopt BR-acala as a universal treatment, but this can be an important treatment option for many patients. I would offer the BR-acala combo in patients who value maximizing duration of treatment response, recognizing this is a continuous regimen. On the other h...
How are you approaching multidisciplinary care for patients with newly diagnosed BCG-naive high-risk NMIBC in light of POTOMAC?
We have not incorporated BCG-naïve high-risk NMIBC patients into our Bladder Cancer Multidisciplinary Clinic workflows to date. That being said, we are discussing including a subset of high-risk patients in our Multidisciplinary Clinic as we incorporate the POTOMAC results into our workflows. In our...
Which patients would you treat with relugolix instead of injectable GnRH agonist therapy?
I would consider relugolix for patients with: 1. Intermediate-risk prostate cancer that needs a short course of androgen deprivation therapy 2. Patients with biochemical relapse that would benefit from a short course of ADT and salvage RT2.5 Patient with pre-existing cardiac comorbidities 3. Potenti...
Would you use a hippocampal sparing technique when treating with PCI for a limited stage small cell lung cancer?
This is an important question where the evidence is evolving, and some key trials remain ongoing. Because the data remains in flux, in the ongoing phase 3 SWOG S1827/Maverick trial of MRI surveillance +/- prophylactic cranial irradiation (PCI) for LS and ES-SCLC, where I serve as the PI, hippocampal...
How do you approach treatment of a glioblastoma in pregnancy?
Glioblastoma during pregnancy could be treated safely (to mother and fetus) with certain precautions and modifications. Collaboration and consultation with the patient’s obstetrician are essential. External shielding over the patient’s abdomen during treatment will decrease the external scatter radi...
What's your follow-up protocol for a near complete response (nCR) in rectal patients considering non-operative management (NOM)?
This is a question that comes up in our colorectal tumor board routinely. For patients with a near-complete response after the completion of TNT, we recommend repeating an MRI of the rectum and endoscopic exam ~8 weeks later. If there is still a lack of complete response, our formal recommendation i...
Is there a role for DDR gene mutation or tumor mutation burden/load in predicting response to immunotherapy in urothelial cancer?
Our recent work showed that urothelial cancers harbor high rate of alterations in DDR (DNA damage repair and response) genes, with 25 – 29% rate of deleterious alterations and up to 25% with variants of unknown significance – considering the genomic complexity of urothelial cancers, it is not un...
In patients with T790M mutation and progression of disease on osimertinib, is there any utility in checking peripheral blood cDNA for continued presence or absence of the T790M mutation?
We strongly believe that there is utility in sending liquid biopsy for T790M positive patients progressing on osimertinib for several reasons. One reason is that there are now identifiable resistance mutations like C797S that may emerge. Depending on their allelic relationship to T790M (cis- versus ...
Have your treatment recommendations for urothelial cancer patients changed given the ongoing COVID19 pandemic?
The therapeutic approach to cancer patients is changing rapidly due to the COVID-19 pandemic. In discussing with colleagues from several different countries, a few themes emerge. Patient visits, surgery, and treatment that is not essential is being deferred. The benefit/risk that we each consider fo...
How long do you continue trastuzumab and pertuzumab after lumpectomy if you included both in a neoadjuvant regimen such as TCH-P?
A total of one year for trastuzumab, including the part with chemotherapy, adjuvant or neoadjuvant. The benefit from addition of pertuzumab, as might have been predicted, was very small, since it is very hard to add any sizable benefit to trastuzumab without some logical risk stratification; for ER ...