Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
What would be your first-line approach to a patient with metastatic HCC with significant bleeding risk?
There is increased risk of variceal bleed with atezolizumab plus bevacizumab. Therefore, EGD is recommended in all patients. The patient can still receive the combination if on anticoagulants. If someone has high risk of variceal bleed, lenvatinib can be used as first line therapy. Lastly, single ag...
How do you manage the thickened secretions secondary to xerostomia during head and neck radiation?
I find that the management of acute effects of RT for H&N treatment is somewhat of a dark art. What works for one patient may not work for another. The thickened secretions are from acute irritation of the salivary glands and not so much from "xerostomia" during the acute phase of RT. For thickened ...
How does the extended PFS data (>4-year median) with taletrectinib impact your choice of frontline therapy and subsequent sequencing approach for ROS1+ NSCLC?
The newest taletrectinib data, in my mind, establishes this as my current (and preferred) first-line option for patients with ROS1+ NSCLC. With the totality of data available, I do not believe crizotinib or entrectinib has a role in the management of patients with ROS1+ NSCLC. Taletrectinib has exce...
Can AMPLIFY data be extrapolated to use of other BTKi's in combination with venetoclax or would you only ever use acalabrutinib/venetoclax in first line?
I prefer NOT to extrapolate results, given that BTKis have unique spectra of kinase activities ("kinomes"), different PK/PD properties (such as half life), different adherence rates and dosing schedules, and have different synergistic (especially in a complex immune context that we are committing to...
Can AMPLIFY data be extrapolated to use of other BTKi's in combination with venetoclax or would you only ever use acalabrutinib/venetoclax in first line?
I prefer NOT to extrapolate results, given that BTKis have unique spectra of kinase activities ("kinomes"), different PK/PD properties (such as half life), different adherence rates and dosing schedules, and have different synergistic (especially in a complex immune context that we are committing to...
In patients with Stage 0 CLL who are clinically doing well and don't warrant treatment, do you typically obtain the CLL FISH Panel and p53 status?
I do a baseline CLL FISH Panel and p53 status on new patients with stage 0 CLL, less for determining treatment options at the moment, and more for an idea of their natural history. For patients with del17p or 11q, I may monitor more closely than patients with a more predicted indolent course.
In patients with Stage 0 CLL who are clinically doing well and don't warrant treatment, do you typically obtain the CLL FISH Panel and p53 status?
I do a baseline CLL FISH Panel and p53 status on new patients with stage 0 CLL, less for determining treatment options at the moment, and more for an idea of their natural history. For patients with del17p or 11q, I may monitor more closely than patients with a more predicted indolent course.
Under what circumstances do you consider an enbloc resection versus biopsy for a lower lumbar spinal column tumor?
Typically, a biopsy is performed prior to en bloc resection rather than “either or.” A biopsy is necessary if there is a differential diagnosis based on imaging, and if the diagnosis will affect management: radiation and chemotherapy alone vs. intralesional resection/debulking and adjuvant therapy v...
Would you consider daratumumab monotherapy as standard of care for smoldering multiple myeloma based on the AQUILA trial?
AQUILA is out! There MIGHT be a survival advantage (p<0.05) to early intervention, but to avoid p-hacking all we have now is a healthy hazard ratio and a confidence interval that juts right up to 1 - it was 0.97. If a patient meets the criteria for this trial, considering Dara makes some sense. I do...
How does one approach maintenance treatment in transplant ineligible patients with newly diagnosed multiple myeloma?
IMROZ and BENEFIT trials are interesting in that they are billed as for transplant-ineligible patients, yet frail patients were excluded, so I don't think they give us the answer for how to maintain a frail patient. The best answer for a frail patient is, I believe, the MAIA trial, which gives DRD t...