Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How do you approach second-line options for relapsed myeloma after front-line quadruplet therapy?
In the second line setting after front-line quadruplet therapy, we are typically talking about patients who are now triple-class exposed and refractory to lenalidomide, with some also being refractory to anti-CD38 therapy. Based on the data from MajesTEC-3, MajesTEC-9, and CARTITUDE-4, there is no q...
How do you approach second-line options for relapsed myeloma after front-line quadruplet therapy?
In the second line setting after front-line quadruplet therapy, we are typically talking about patients who are now triple-class exposed and refractory to lenalidomide, with some also being refractory to anti-CD38 therapy. Based on the data from MajesTEC-3, MajesTEC-9, and CARTITUDE-4, there is no q...
With the recent FDA approval of nipocalimab and the emerging LUMINA 2 data for rilzabrutinib, what is your approach to wAIHA refractory to or relapsed after steroids and rituximab?
Probably because of its rarity (1–3 new cases per 100,000 people), we often joke that there are more treatments at our disposal for the management of wAIHA than the number of cases any hematologist sees on an annual basis—or even during their lifetime. A partial list includes typical first-line trea...
In the current era of adjuvant CDK4/6 inhibitor use for high-risk HR+/HER2-negative breast cancer, what is the preferred adjuvant chemotherapy regimen for premenopausal women — AC-T or TC?
In premenopausal women with genuinely high-risk HR+/HER2- disease (MonarchE and some NATALEE groups, especially Stage III), I believe there remains a role for dose-dense AC/T as the adjuvant chemotherapy backbone. Data from EBCTCG do portray a 2.5–2.6% 10-year recurrence and 1.6% 10-year breast canc...
In light of promising results of hydroxychloroquine in COVID-19, should we consider using it prophylactically in cancer patients, especially if immunocompromised?
At this time, as there is no good evidence available, I would not recommend the use of hydroxycholoroquine prophylactically in cancer patients. It is unclear whether it would prevent contagion, probably not, and we still don't know if it will have any effect on the course of COVID-19. We expect ther...
What are your top takeaways from ASCO GU 2025?
In terms of practice-informing presentations in prostate cancer here are my top 3: GROUQ-PCS 9 trial (Canada, abstract 22). This trial led by Niazi et al tested whether metastasis-directed radiotherapy based on conventional imaging to up to 5 sites provided benefits in delaying rPFS or PSA progressi...
Should axillary imaging be routinely performed in all patients with a new diagnosis of breast cancer?
This issue has been debated but I would argue that patients with a new diagnosis of breast cancer should not undergo routine screening US of the axilla to look for clinically occult disease. The axillary US should be limited to diagnostic imaging for clinically suspicious nodes on clinical exam or b...
In patients with newly diagnosed HER2+ early breast cancer who may be eligible for both neoadjuvant or adjuvant T-DXd, what will be your standard sequencing?
Trastuzumab deruxtecan (T-DXd) is currently recommended in the adjuvant setting for patients with residual invasive disease after neoadjuvant therapy, based on the DESTINY-Breast05 trial, while its use in the neoadjuvant setting remains investigational.Ongoing neoadjuvant trials are evaluating T-DXd...
Do you recommend frontline bevacizumab with carbo/taxol in patients with advanced epithelial ovarian and BRCA mutation who will be receiving olaparib maintenance?
As shown in GOG-218, there is no apparent benefit to using concurrent bevacizumab with paclitaxel and carboplatin in the first-line setting, if this drug is not then continued during maintenance therapy. Our approach is to obtain genetic testing in patients with epithelial ovarian cancer as soon as ...
How do you prevent radiation induced colitis?
My primary strategy to prevent radiation-induced acute large bowel injury is to try to minimize the dose delivered to the bowel as much as possible. In patients who I think might be at high risk of developing this problem, I will give them written instructions about diet modifications (low fiber, lo...