Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Do you consider omitting adjuvant radiation therapy in an older patient with node positive TNBC who achieve pCR to neoadjuvant chemotherapy?
It depends on what surgery the patient has received. If lumpectomy plus SLNB, I would not omit unless there is absolute contraindications, intolerance to radiation therapy. PRIME II, CALGB 9343, and this meta-analysis provided evidence that post lumpectomy radiation therapy can be omitted in women >...
What would be an appropriate chemotherapy de-escalation strategy for patients with metastatic TNBC on pembrolizumab/chemotherapy with CR and negative ctDNA?
My inclination would be to stop the chemotherapy but continue pembrolizumab indefinitely, in the absence of an immune-related adverse event (that can't be easily controlled, such as hypothyroidism).
Is there a role in sending liquid biopsy for patients progressing on ALK inhibitors?
We believe there is increasing value in testing for acquired resistance mechanisms and thereby sending liquid biopsies in patients who progress on ALK inhibitors. The importance was not previously observed as much in patients who progress on first generation crizotinib, since many patients will resp...
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...
When do you recommend PD-L1 testing for patients with recurrent cervical cancer?
I think getting the testing done as soon as possible is best because very few patients will only need first line therapy. This way, there is less of a delay at the time of progression following/during first-line therapy.
How do you choose among regimens for relapsed refractory myeloma?
To be brief - no one chooses elotuzumab with no single agent activity if Daratumumab is available, with its approximate 30% response rate in its pivotal study. I was just sitting down at a meeting with a number of myeloma physicians asking how do we currently choose treatment for relapsed myeloma.Fo...
How do you choose among regimens for relapsed refractory myeloma?
To be brief - no one chooses elotuzumab with no single agent activity if Daratumumab is available, with its approximate 30% response rate in its pivotal study. I was just sitting down at a meeting with a number of myeloma physicians asking how do we currently choose treatment for relapsed myeloma.Fo...
Based on the DREAMM-7 and DREAMM-8 data, how would you incorporate belantamab mafadotin in your practice?
This is definitely top of mind with the publication of the DREAMM, BENEFIT, and IMROZ trials. Given my standard sequencing of myeloma treatments in non t(11;14) patients who are not clinical trial candidates, there is no longer a good time to incorporate a toxic BCMA antibody drug conjugate into the...
Would you give consolidation durvalumab to a patient who underwent chemoradiation for his stage III NSCLC and is being started on antifibrotic therapy by pulmonology for his ILD?
This is a difficult scenario. On the one hand, we know from the PACIFIC trial that there is a clear benefit to the addition of durvalumab in this setting. On the other hand, there is a higher risk of pneumonitis due to both the prior use of radiotherapy and the history of underlying ILD. I think ECO...
How does the extended PFS data (>4-year median) with taletrectinib impact your choice of frontline therapy and subsequent sequencing approach for ROS1+ NSCLC?
Overall favorable and is the preferred 1L option for newly diagnosed advanced ROS1+NSCLC, and also the preferred 2L option in my practice currently for those who were started on older approved agents such as crizotinib. Better balance between efficacy and toxicity profile compared to other available...