Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
What is your approach to iron deficiency anemia after a negative EGD and colonoscopy?
If there is no sign of atrophic gastritis and repeated fecal tests for blood are negative, I’d look first for celiac disease. If all the celiac screening tests rule it out, then I might team up with a hematologist to look for rare birds like transferrin deficiency. I’d probably ease back on PPIs if ...
Would you consider upfront, time-limited anti-IL-5 therapy for I-HES or L-HES to avoid steroid side effects?
There are two parts to this question: Are there better options than steroids for the treatment of iHES and L-HES? The answer is an emphatic yes. These are chronic diseases, and steroids are really not the optimal therapy. IL-5 inhibitors such as mepolizumab and benralizumab are effective in reducing...
How would you manage locally advanced, resectable gastric cancer that is MSI-H?
I would not recommend FLOT + durvalumab for MSI-H gastric/GEJ patients. I say this because there is mounting evidence that chemotherapy may not provide a significant benefit for these MSI-H patients at all (1). All efforts should be made to spare this patient population from getting cytotoxic chemot...
If a pregnant patient with a mechanical heart valve takes warfarin throughout her pregnancy, what are the chances that the fetus will be harmed?
Warfarin is effective for thromboembolic prevention in pregnant patients with mechanical valves. There is however an overwhelming evidence that warfarin taken during pregnancy is deleterious to the fetus. Its use during the first 6–12 weeks of gestation can be associated with important fetal complic...
Would you recommend ISRT for an initially bulky nodular lymphocyte predominant Hodgkin lymphoma with complete metabolic response after 4 cycles of R-CHOP?
Nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) is a rare subtype of Hodgkin lymphoma. Approximately 95% of Hodgkin lymphoma cases are classified as classic Hodgkin lymphoma, including the nodular sclerosis, mixed cellularity, lymphocyte-rich, and lymphocyte-depleted subtypes, all of which a...
When treating rectal cancer with TNT and induction chemotherapy first, do you repeat pelvic MRI prior to planning for chemoradiation?
TNT approach options for pMMR T3, N any; T1–2, N1–2; T4, N any or locally unresectable or medically inoperable rectal cancer patients include:First chemotherapy for 12-16 weeks (FOLFOX or CAPEOX may also consider FOLFIRINOX) followed by long-course chemoradiation or short-course radiation, followed ...
In patients with advanced HR+, HER2- breast cancer who have progressed on first-line CDK 4/6i and ET and found to have ESR1 mutation, are you offering combination of abemaciclib and elacestrant in the 2nd line or SERD monotherapy?
In my practice, when treating patients with advanced hormone receptor-positive (HR+), HER2-negative breast cancer who have progressed on first-line CDK4/6 inhibitors and endocrine therapy, and who harbor ESR1 mutations, I typically consider elacestrant monotherapy as the preferred second-line treatm...
At what time points during a patient's treatment for metastatic ER+ breast cancer are you checking liquid NGS for endocrine pathway alterations?
Traditionally, liquid NGS testing for PIK3CA, PTEN/AKT/PIK3CA, and ESR1 alterations has been performed at discrete clinical decision points, primarily at progression on endocrine therapy or when considering targeted agents.Currently, I order NGS at disease onset, even for those who do not fit INAVO ...
How do you select between imlunestrant ± abemaciclib and elacestrant for those with an ESR1 mutation and progressed on AI and CDK4/6 inhibitor for patients with metastatic ER+/HER2- breast cancer?
My choice of oral SERD to use in this setting would be based on side-effect profile and ease of administration, as both are approved for use after progression on 1st-line ET. Based on information from the phase III trials, EMERALD and EMBER-3, and in the absence of a head-to-head comparison, imlunes...
For ALK positive NSCLC, where in treatment sequencing do you utilize lorlatinib?
The CROWN trial was one of the most important trials reported in the field of lung cancer in 2020. The results of this trial with a median follow up of 18 months were presented by Dr. Ben Solomon at ESMO 2020. The HR for Investigator assessed PFS in this trial with lorlatinib was 0.21 (0.28- Indepen...