Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
What are your top takeaways in Neuro Oncology from ASCO 2025?
Aizer et al., JCO 2025 - A multi-instituitional Brigham Dana-Farber-led trial randomized 196 patients with 5-20 brain metastases to stereotactic radiosurgery (SRS) or hippocampal avoidance whole brain radiotherapy (HA-WBRT). Patients treated on the SRS arm had significantly less symptom burden, wit...
How, if at all, have you incorporated GLP-1 agonists into your fertility-sparing management of patients with EIN or endometrial cancer?
That is a question that needs to be more clearly defined. We have a project in our endometrial SPORE grant that seeks to answer that question. This project is led by Andrea Hagemann at Washington University. In this project, the effect of weight loss, augmented by GLP1 agonists with weight loss coun...
How are you interpreting the early RASolute 302 trial findings (daraxonrasib) in metastatic PDAC?
Update 6/2/2026: Well, this plenary abstract exceeded my expectations. That p-value! The possibilities for pancreas cancer treatment, it's a dream realized for our patients. Now, we need to keep our eye on the FDA to approve this quickly, and we also need to keep pushing for RAS inhibition in all p...
Would you offer adjuvant chemotherapy to a premenopausal woman with HR+ HER2 negative IDC, T1cN0, with isolated tumor cells, oncotype RS 20, grade 2, with multifocal LVI?
First - isolated tumor cells have no clear impact on prognosis and should NOT be used to alter local or systemic treatment decisions. The TAILORx trial unplanned subgroup suggested a small but real benefit from chemo. However, very few (11%) of premenopausal patients got optimal HRT that included OF...
How would you manage a young patient with Sjogrens disease with extranodal marginal zone lymphoma involving bilateral parotid glands with bilateral cervical lymphadenopathy?
For patients with low-grade NHLs (e.g., follicular lymphoma, marginal zone lymphoma), staging dictates treatment. If a patient has a localized process (e.g., contiguous stage I-II disease), then a definitive course of RT is typically recommended. The conventional approach is 24-30 Gy, though a dose-...
When do you consider consolidation chest radiation in a patient with stage IV non-small cell carcinoma of the lung who has had good response to systemic therapy?
It's a really great question, and it comes up a lot in our tumor boards and general practice. There are a couple of paradigms that I use to help me think through when and how to do it. I would say the data here for the use of RT is mixed, and either gives you freedom to do a variety of things or giv...
When selecting mCRPC patients for Pluvicto, which baseline variables do you find most useful or predictive of potential hematologic toxicity?
One important consideration in the recommendation of Lu-177-PSMA radiopharmaceutical therapy (RPT) is an assessment of a patient’s marrow reserve, as hematologic toxicity is one of the most common clinically relevant toxicities after such treatment. Important clinical features to help assess the lik...
Would you consider neoadjuvant immunotherapy prior to radiation for a locally advanced skin squamous cell carcinoma?
While the definitive trials are yet outstanding and enrollment in NRG HN0014 (NCT06568172) should be encouraged where it is open, the present indications for using cemiplimab should follow its principal indication, unresectable cutaneous squamous cell cancer, a minority of cases at 5%. Practically s...
What are your top takeaways in Breast Cancer from ASCO 2025?
My Top 3 takeaways in Breast Cancer from ASCO 2025 ASCENT-04: Sacituzumab Govitecan Plus Pembrolizumab as a New First-Line Standard for Metastatic PD-L1-Positive Triple Negative Breast Cancer (TNBC): The treatment landscape for metastatic TNBC continues to evolve rapidly. At ASCO 2025, presentation ...
What are your management strategies for malignant pericardial effusion with a high risk of spontaneous hemorrhage, particularly in patients requiring anticoagulation for chronic atrial fibrillation?
We have many patients with malignant pericardial effusion who tolerate anticoagulation for DVT/PE/afib. In those patients, when AC is restarted (for example after pericardiocentesis), close monitoring with serial echo in a few days would be performed to see if effusion reaccumulates faster. Also, th...