Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
What factors drive your selection between tafasitamab and epcoritamab for a patient with relapsed/refractory follicular lymphoma?
For an older patient or a patient with comorbidities, if one is prioritizing outpatient simplicity, tafasitamab + R² delivers an NCCN category 1 benefit with substantially lower acute immune toxicity. If CD19 CAR-T is the next planned therapy, however, the CD19-targeting overlap is a consideration t...
Following the ECHO trial, are you routinely incorporating acalabrutinib plus bendamustine-rituximab into your frontline treatment approach for patients with MCL?
I routinely discuss the combination of BR+ acalabrutinib for my patients with TP53 WT disease, but am upfront that it is not a "once size fits all" approach. I discuss that we are clearly seeing a progression free benefit of adding acala to BR, but we don't actually know at this time if giving them ...
Following the ECHO trial, are you routinely incorporating acalabrutinib plus bendamustine-rituximab into your frontline treatment approach for patients with MCL?
I routinely discuss the combination of BR+ acalabrutinib for my patients with TP53 WT disease, but am upfront that it is not a "once size fits all" approach. I discuss that we are clearly seeing a progression free benefit of adding acala to BR, but we don't actually know at this time if giving them ...
In which clinical situations, if any, would you still consider carboplatin-paclitaxel alone rather than chemoimmunotherapy for first-line treatment of metastatic squamous anal cancer after POD1UM-303/InterAACT-2?
I think there are still rare patients who have significant autoimmune conditions requiring DMARDs or steroids where I would forgo IO. Otherwise, would routinely offer.
Would you favor starting with pembrolizumab or chemotherapy for a metastatic MSI-high pancreatic ductal adenocarcinoma?
This is a great question. MSI-H status in PDAC is rare, about 1-2% of all PDAC (Luchini et al., PMID 32350089). Marabelle and colleagues published one of the initial studies using pembrolizumab in MSI-H solid tumors showing a response rate of 18.2% among PDAC (22 patients) with a median duration of ...
Would you offer empiric lung SBRT for two growing FDG-avid lung lesions in a patient with severe COPD on oxygen?
This is a good question! The short answer is yes, most likely. Many patients are too high-risk to receive biopsies; this is decided by surgery/pulm/IR. Unless the patient has contraindications to RT or something like severe IPF (where treatment may be worse than the disease), I would likely offer th...
How do you counsel patients and caregivers regarding management of cancer-associated cachexia?
ASCO guidelines re: anorexia/cachexia were just published in May 2020. Basically, they note the magnitude of the clinical problem and the limited therapeutic options proven to be helpful. They state that dietician consultation is reasonable to employ. They also note that it is reasonable for a clini...
In light of the recent results from STAMPEDE and LATITUDE, to which patients with newly diagnosed metastatic prostate cancer are you offering up-front abiraterone vs. up-front docetaxel?
Although I anticipate that the Stampede investigators will publish (an underpowered) comparison of their ADT plus docetaxel arm vs ADT plus abiraterone which may provide some insight, for the most part we will be in a data free zone re: this issue for some time. I suspect that clinicians will contin...
How do the results of LIBRETTO-432 shape the potential role of adjuvant selpercatinib in patients with early-stage RET fusion-positive NSCLC?
The results of LIBRETTO-432 provide strong evidence to consider selpercatinib for patients with stage II-IIIA RET fusion-positive NSCLC, with a highly significant HR of 0.172 (0.058-0.59) for this cohort. When thinking about stage IB (tumors 3- 4 cm, T2b), most of these patients were not included in...
When do you suggest ovarian suppression for fertility preservation in premenopausal women receiving neo/adjuvant chemotherapy?
The benefit of ovarian suppression in young breast cancer patients should be looked into from two different aspects. First, the suppression of the ovary resulting in the hormone receptor-dependent cancer stem cell (minimal residual disease) suppression, and second, the preservation of the fertility ...