Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Would you offer first line atezolizumab plus bevacizumab in unresectable/metastatic hepatocellular carcinoma based on the IMbrave 150 data?
I would definitely discuss (and offer) atezolizumab/bevacizumab as first-line therapy for advanced HCC and in fact, I have already started the treatment in 3 patients. There is no denying that this is the greatest advance in first-line therapy since the presentation/publication of the SHARP trial an...
In what clinical scenario would you consider liver transplant evaluation for a patient with sickle cell hepatopathy?
We have evaluated and transplanted patients with sickle cell hepatopathy with severe liver dysfunction but well-controlled sickle cell. These patients will typically have jaundice, coagulopathy, and biliary strictures. They should not have significant extrahepatic complications of the hematologic di...
Do the results of IMvigor011 influence you to utilize ctDNA to guide all adjuvant IO in MIBC?
Based on ESMO '25 data, I am using ctDNA in ICI-naive patients s/p radical cystectomy (with or without neoadjuvant chemotherapy) to inform the decision & timing of potential adjuvant nivolumab (FDA-approved) (following IMvigor011 design). I acknowledge the logistical burden of every-6-week ctDNA tes...
Would you use triplet chemotherapy FLOT in lieu of chemoRT for patients with localized esophageal squamous cell carcinoma?
This is a timely question in esophageal SCC (ESCC), even as we adjust to the now markedly diminished role of pre-operative chemoradiation vs. FLOT in esophageal/GEJ adenocarcinoma, based on the recent phase III ESOPEC study [Hoeppner et al., ASCO 2024; LBA1] (as well as the NeoAEGIS study that prece...
Does stage of resected EGFRm NSCLC impact your treatment decisions for use of adjuvant osimertinib?
Yes, to some degree; it informs the risk/benefit ratio when I discuss adjuvant osimertinb with patients. The benefit of adjuvant osimertinib was seen in stages 1B, 2 and 3 but the magnitude of the benefit increased with higher stages. This makes sense because the risk of recurrence increases with in...
What is your approach to initial management of patients with suspected or confirmed primary cutaneous CD8+ positive aggressive epidermotropic T- cell lymphoma (PCAECTCL)?
PCAECTCL is an exceptionally rare and clinically aggressive subtype of cutaneous T-cell lymphoma, characterized by a rapidly progressive course, ulcerated or necrotic skin lesions, and early dissemination to extracutaneous sites. Due to its rarity and lack of standardized guidelines, management is l...
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...
In a newly diagnosed elderly patient with AML who harbors an IDH1 mutation, would you treat with upfront with ivosidenib/HMA or would you proceed with venetoclax and HMA as your first line treatment?
For me, the decision whether to treat this patient with IDH1 inhibitor monotherapy (ivosidenib) vs. venetoclax/HMA depends on how fit this patient is and his/her desire for aggressive therapy and inpatient vs ambulatory care. Prior data suggests very high response rates (90-100%) following venetocla...
In a newly diagnosed elderly patient with AML who harbors an IDH1 mutation, would you treat with upfront with ivosidenib/HMA or would you proceed with venetoclax and HMA as your first line treatment?
For me, the decision whether to treat this patient with IDH1 inhibitor monotherapy (ivosidenib) vs. venetoclax/HMA depends on how fit this patient is and his/her desire for aggressive therapy and inpatient vs ambulatory care. Prior data suggests very high response rates (90-100%) following venetocla...
How do you decide among AI, full dose tamoxifen and low dose tamoxifen in a postmenopausal woman with DCIS without contraindications to either therapy?
My decision about AI vs tamoxifen is based on comparing the risk/benefit ratio for the specific patient. The cause of mortality in post-menopausal women is primarily cardiovascular disease, with osteoporosis also causing significant morbidity and mortality. Degenerative joint disease adversely affec...