Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How would you approach the management of a patient with Stage IV NSCLC harboring both a classical and non-classical compound EGFR mutations?
I was asked to dust off q prior Mednet discussion on frontline treatment selection for patients with a new diagnosis of advanced common EGFR mutation+ NSCLC in light of recent updates on both the key FLAURA2 and MARIPOSA trials. And indeed the timing seems ripe for such not just due to these updates...
How would you approach a patient with HR+, HER2- metastatic breast cancer who is endocrine resistant, with bone marrow involvement and pancytopenia?
Symptomatic bone marrow involvement (bone marrow carcinomatosis) is extremely rare in metastatic breast cancer and carries very poor prognosis. It is often associated with microangiopathic hemolytic anemia and DIC. Anemia is the most common manifestation and WBC and platelet counts are often not tha...
Is there a role for DDR gene mutation or tumor mutation burden/load in predicting response to immunotherapy in urothelial cancer?
Our recent work showed that urothelial cancers harbor high rate of alterations in DDR (DNA damage repair and response) genes, with 25 – 29% rate of deleterious alterations and up to 25% with variants of unknown significance – considering the genomic complexity of urothelial cancers, it is not un...
How do you approach a patient with IgM monoclonal gammopathy associated with severe neuropathy of unclear etiology?
I usually confirm if the patient does not have AL Amyloidosis or POEMS, and as part of work up for IgM MGUS, I order MYD 88 mutation. If all are negative and I still believe that neuropathy is caused from his/her MGUS, you can try IVIG for the neuropathy as a trial (of course after using gabapentin,...
How do you approach a patient with IgM monoclonal gammopathy associated with severe neuropathy of unclear etiology?
I usually confirm if the patient does not have AL Amyloidosis or POEMS, and as part of work up for IgM MGUS, I order MYD 88 mutation. If all are negative and I still believe that neuropathy is caused from his/her MGUS, you can try IVIG for the neuropathy as a trial (of course after using gabapentin,...
How will the ADAURA study impact your use of adjuvant chemotherapy?
ADAURA has not and will not impact my use of adjuvant chemotherapy. Many prospective studies have demonstrated a clear significant improvement in overall survival with the use of adjuvant chemotherapy after complete surgical resection. This is standard of care for the appropriate patients. Osimertin...
In your practice, would you consider the all-oral option of decitabine-cedazuridine + venetoclax for an elderly, unfit AML patient, based on the ASCERTAIN-V trial results?
I see the combination of oral decitabine-cedazuridine (ASTX727) + venetoclax as largely being an appropriate option for any patient with newly diagnosed AML that would be otherwise considered for azacitidine + venetoclax. The inclusion criteria for ASCERTAIN-V (Roboz et al., PMID 42235013) and VIALE...
In your practice, would you consider the all-oral option of decitabine-cedazuridine + venetoclax for an elderly, unfit AML patient, based on the ASCERTAIN-V trial results?
I see the combination of oral decitabine-cedazuridine (ASTX727) + venetoclax as largely being an appropriate option for any patient with newly diagnosed AML that would be otherwise considered for azacitidine + venetoclax. The inclusion criteria for ASCERTAIN-V (Roboz et al., PMID 42235013) and VIALE...
Are there any alternative, hypofractionated RT courses for patients with DLBCL that can be used during the COVID-19 pandemic?
ILROG recently came out with guidelines pasted below: Synopsis of ILROG Recommendations for Administering Radiotherapy for Hematological Malignancies During Emergency Conditions of the COVID-19 Pandemic • We are facing an increased demand for RT to substitute or complement systemic therapy deemed i...
Does TROP2 expression influence clinical decision-making for TNBC currently?
At this time, TROP2 IHC expression does not guide treatment selection for TROP2-directed ADCs in TNBC clinical practice. Exploratory biomarker analyses from ASCENT and TROPiCS-02 demonstrated that benefit from sacituzumab govitecan was observed across a range of TROP2 expression levels, without a cl...