Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
What dose of radiotherapy do you use for low volume Castleman's disease?
Reports in the literature are varied in terms of radiation dose. For scenarios such as this with low volume disease, it is probably reasonable to consider the lower end of ranges reported by others to be successful, such as 30 Gy. Careful pathology review is important for these cases as well. One mu...
Do you check IGHV mutation status in patients with newly diagnosed CLL?
Yes. In the targeted therapy era, there are three factors that continue to have prognostic and therapeutic significance and should be checked: IgHV mutation status p53 aberrancy - requires both FISH for del17p AND mutation analysis for p53 Complex karyotype - can be done on peripheral blood or marr...
Do you check IGHV mutation status in patients with newly diagnosed CLL?
Yes. In the targeted therapy era, there are three factors that continue to have prognostic and therapeutic significance and should be checked: IgHV mutation status p53 aberrancy - requires both FISH for del17p AND mutation analysis for p53 Complex karyotype - can be done on peripheral blood or marr...
What is your recommendation for patients who are on weight loss medications like GLP-1-based therapies while receiving chemoradiation for head and neck cancer?
I recommend immediate discontinuation of GLP-1-based therapies. Increased risk of nausea/vomiting and weight loss certainly aren't side effects we need during head and neck chemorads. Additionally, there is concern that these agents, even outside of cancer patients, contribute to sarcopenia, which h...
What are your top takeaways from SGO 2026?
A pivotal theme of SGO 2026 was the dramatic rise in ADCs in every gynecologic cancer, from front-line to recurrent disease. Along with notable updates for several studies, data from others were treatment-defining. (1)The following studies were selected for further review.Ovarian Cancer: Low-grade s...
In light of the pending overall survival data and reported declines in quality of life associated with the PSMAddition trial, how do you envision incorporating Pluvicto into the management of mHSPC?
The PSMAddition trial was a phase III trial of [177Lu]Lu-PSMA-617 (i.e., Pluvicto) combined with androgen deprivation therapy (ADT) plus an androgen receptor pathway inhibitor (ARPI) in patients with PSMA-positive metastatic hormone-sensitive prostate cancer (mHSPC). This trial randomized men with u...
How would you manage a patient with metastatic NSCLC and high-level MET amplification who achieved a near CR on tepotinib but is unable to tolerate dose-reduced tepotinib?
This is one of the more challenging situations I face in the clinic. Peripheral edema is the most notorious side effect of MET TKIs, with an insidious onset of 6-9 weeks after initiation of therapies like capmatinib or tepotinib [Sakamoto and Patil, PMID 36924573; Lin et al., PMID 40386723]. You hav...
How do you approach patients who are inappropriately worried/fixated on a test result that is flagged as abnormal but not clinically significant?
This happens all the time now. I tell them that those results were flagged as outside the reference range (I don't use the term abnormal) but that they are not clinically significant. It does not always work if there is a patient who is super anxious or hyper-focused. Typically, if they need a lot m...
How do you approach patients who are inappropriately worried/fixated on a test result that is flagged as abnormal but not clinically significant?
This happens all the time now. I tell them that those results were flagged as outside the reference range (I don't use the term abnormal) but that they are not clinically significant. It does not always work if there is a patient who is super anxious or hyper-focused. Typically, if they need a lot m...
What is your approach to mitigating the infection risk with bispecific antibodies in multiple myeloma?
As of June 2023, anybody who says they have a definite answer to this is misleading you. We are unfortunately learning as we go, and LOTS of loose ends to be tied up. I'd argue everybody in this setting should already be on universal VZV prophylaxis (e.g., acyclovir), and I'd also argue that most of...