Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How do you think about sequencing therapy for a patient with ALK+ metastatic NSCLC given the available options?
The types and incidence of resistance mutations vary based on the 2nd generation ALK inhibitor given, and is most commonly the G1202R mutation, which unfortunately denotes resistance to alectinib where it accounts for about 29% of acquired resistance and brigatinib where it accounts for about 43% of...
What are your top takeaways in Gyn Cancers from ESMO 2025?
Studies presented at ESMO 2025 give a glimmer of hope to patients with platinum-resistant ovarian cancer, an area of gynecologic oncology where too little progress has been made. There were also numerous trials (too many to discuss here) presented involving ADCs, along with important updates to prev...
Are you offering Lutathera for multiple recurrent meningiomas?
Lutathera is currently only FDA-approved for treating somatostatin receptor-positive gastroenteropancreatic neuroendocrine tumors (GEP-NETs). However, research is ongoing to explore its potential use for meningiomas, as many meningiomas express somatostatin receptors, which could make it a promising...
How do you manage persistent cytopenias after FCR chemotherapy for treatment of CLL?
For persistent cytopenias after FCR, the initial approach would be supportive care. If no recovery after 12 weeks, consideration should be for a bone marrow biopsy to evaluate for aplasia, an autoimmune process like PRCA, or early MDS. The therapy after the bone marrow would be based on the result. ...
How do you manage persistent cytopenias after FCR chemotherapy for treatment of CLL?
For persistent cytopenias after FCR, the initial approach would be supportive care. If no recovery after 12 weeks, consideration should be for a bone marrow biopsy to evaluate for aplasia, an autoimmune process like PRCA, or early MDS. The therapy after the bone marrow would be based on the result. ...
What is your approach to a situation where DILI is suspected secondary to an important medication (e.g., anticoagulation, antibiotics, etc.), but the diagnosis is uncertain and the liver injury is relatively mild?
If the drug suspected to induce liver injury causes symptoms and ALT is >3 times the upper limit of normal (ULN), I would stop the drug and find an alternative. Even if no symptoms are present, I would stop if ALT is >5 times ULN. Any level increase of ALT below the above parameters would still requ...
What is your experience with Pylarify vs. Posluma PSMA PET for prostate cancer and is one preferred over the other?
There is no definitive evidence at this time that one of these imaging agents is clearly superior to the other because there are no comparative data in the same patient group.For Posluma, the potential benefit over Pylarify would be lower bladder excretion allowing for better visualization of the pe...
How do you approach delivery planning in patients with T1 vWD?
For VWD, I recommend that the mode and timing of delivery be obstetric-based (i.e., the presence of VWD has no effect on the decision). If a CSX is needed, I consider an epidural safe if preceded by VWD-specific therapy. I base the duration of VWD-specific therapy on clinical history and 3rd-trimest...
Have you had patients who wish to take ivermectin and/or fenbendazole as adjunct treatments for gynecologic cancers, and if so, how have you handled this?
Since COVID, there are definitely more patients interested in ivermectin and/or fenbendazole, as well as other alternative therapies. I will counsel the patients on the data for standard of care therapy, but also acknowledge that it is also their body, their life, and ultimately their choice what tr...
Is there evidence supporting the use of nab-paclitaxel in place of paclitaxel in the KEYNOTE-522 neoadjuvant regimen for triple-negative breast cancer, in cases of paclitaxel hypersensitivity?
While I am not aware of any evidence on the specific substitution of nab-paclitaxel for paclitaxel in the KEYNOTE-522 regimen, there is certainly data on the efficacy of nab-paclitaxel in the neoadjuvant setting in a variety of breast cancer subtypes, For example, in the ETNA trial (Gianni et al., P...