Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Is there any outpatient protocol for cisplatin/doxorubicin neoadjuvant chemotherapy for osteosarcoma?
Outpatient administration of cisplatin/doxorubicin (albeit at a slightly reduced cisplatin dosage of 100 mg/m²) protocol is documented in the BC Cancer out in Vancouver, British Columbia. We offer this at Roswell, with the addition of mannitol, but it is a long 8-hour day, and close follow-up is rec...
How do you approach adjuvant therapy for resected lung adenocarcinoma that was found unexpectedly postop to be N2?
Preliminary results of the phase 3 randomized LungART trial (NCT00410683) were recently presented at a virtual ESMO conference. 501 patients with pathologically confirmed N2 NSCLC s/p complete resection were randomized to postoperative RT (54 Gy) or observation. Almost all patients received chemothe...
What are your top takeaways in Medical Oncology from SABCS 2025?
lidERA trial. This is the first phase III trial showing an advantage for an oral SERD giredestrant over standard endocrine adjuvant therapy in early breast cancer. Treatment with giredestrant led to a 30% reduction in the risk of invasive disease recurrence over standard endocrine therapy at the fir...
What are your top takeaways in Breast Cancer from ESMO 2025?
ASCENT-03: At ASCO, the results of ASCENT-04 already showed an improvement of PFS (11.2 months vs. 7.8 months) in first-line setting for PD-L1 positive advanced triple negative breast cancer patients treated with sacituzumab plus pembrolizumab compared to chemotherapy plus pembrolizumab. The ASCE...
Do you recommend using a ctDNA assay for a patient with HER2+ metastatic breast cancer in a continued CR to guide decision about whether to stop HER2-directed therapy?
This is a good question and is not a rare situation in the management of HER2+ metastatic breast cancer. Radiographic complete response occurs with first-line treatment in 6-15% (CLEOPATRA, GIM-14, and other trials). Currently, the standard of care is to continue anti-Her2 therapy indefinitely. Howe...
How would you approach treatment for a HR+ HER2+ clinical T1c N0 male breast cancer?
If clinically node negative, he can receive surgery and then once confirmed to be pT1c pN0, you could provide the TH regimen (weekly paclitaxel x 12 cycles plus trastuzumab for one year). However, my favorite approach would be to give the same regimen in the neoadjuvant setting so that I can re-disc...
Do you regularly perform pharmacogenomic testing for patients prior to starting chemotherapy?
At my center, we routinely perform DPYD genotyping prior to chemotherapy with 5-FU or capecitabine. This is a practice that is supported by very strong evidence from multiple prospective studies (see especially Henricks et al., PMID 30348537). The most important benefit of screening for DPD deficien...
Would you recommend imatinib 400 mg BID or stay with the usual dose of 400 mg/day for adjuvant therapy for a patient with intermediate-high risk exon 9 mutated GIST?
This is an issue that has been debated for more than 10 years with no clear-cut evidence-based answer. A case can be made for both options. I personally start with 400 mg/d, watch the disease closely, and the first indication that the benefit is in question, increase the dose to 800 mg/d. Tolerance ...
When do you opt to administer IV iron for patients with heart failure who may also have anemia of chronic disease or at risk for iron deposition disease?
I do not hesitate to administer IV iron in a patient with heart failure (chronic inflammation) if serum ferritin levels are <30 ng/ml and TSAT is under 20%. This is the only way, besides blood transfusions, to improve Hgb levels in this patient population.
What is your preferred treatment for patients with painful gynecomastia on anti-androgen therapy for prostate cancer?
Gynecomastia can be a significant morbidity affecting the quality of life in patients on androgen deprivation therapy, especially in patients who receive bicalutamide as monotherapy or at higher doses such as 150 mg a day. In patients who are younger and/or who may spend time in public without their...