Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
What are the recommended second-line treatment options for patients with metastatic HER2+ breast cancer who have received frontline trastuzumab deruxtecan (T-DXd)?
There is currently limited direct evidence to guide optimal sequencing after frontline trastuzumab deruxtecan, so second-line treatment decisions are individualized. In many cases, the HER2CLIMB regimen with tucatinib, capecitabine, and trastuzumab is an appealing option, particularly for patients w...
What is your approach to chronic non-immune mediated thrombocytopenia management in children?
There are whole textbook chapters on this topic, and we use a variant of this question to review the differential diagnosis of thrombocytopenia with our fellows as a didactic exercise. So I take from this question, which is an important one, what might be a framework to consider the differential dx ...
How would you approach a patient with metastatic HR+, HER2-negative, high-grade neuroendocrine carcinoma of the breast?
Carbo/VP16.
After the MAJESTEC-3 results, what is your approach to choosing between tec-dara vs. cilta-cel versus another triplet for multiple myeloma in first relapse?
This is an excellent question, and literally a million-dollar question for various companies involved. It's worth noting that the US FDA can change the package insert at will (and has done so) compared to what the trials did, so there's no guarantee as of yet that Tec-Dara (based on MajesTEC-3) will...
Would you implement CAR-T therapy earlier in practice if approved in earlier lines for multiple myeloma based on the KarMMa-3 and CARTITUTUDE-4 studies?
I agree with @Dr. First Last's excellent take on CARTITUDE-4 and KarMMA-3. For patients who have had 2 prior lines of therapy, I am absolutely going to reach for CAR-T (or bispecific antibodies as their earlier-line studies get published) with an emphasis on cilta-cel based on the data at hand.But w...
What is your preferred first-line therapy for transfusion-dependent beta-thalassemia?
Transfusions are the backbone of therapy for these individuals. Reducing transfusion burden is advantageous to minimize iron loading, space out transfusions, and improve quality of life. At present, there are 2 agents available - luspatercept and mitapivat. The clinical trial endpoints for both are ...
What is your approach to liver transplantation candidacy in those with decompensated cirrhosis who have been treated for a solid-organ malignancy, such as oral SCC?
This is an important consideration as patients who receive a solid organ transplantation will be on significant immunosuppression, which can result in significant proliferation of an underlying malignancy and have worse treatment outcomes compared to non-immunosuppressed patients. Furthermore, patie...
What criteria is needed in relapsed/refractory B-cell ALL to choose CAR-T therapy over conventional stem cell transplant as destination therapy?
Currently, there are no standard criteria used to choose CAR-T over conventional stem cell transplant as destination therapy. However, there are many factors that often push us in one direction or the other. As we learn more about outcomes after CAR-T cell therapy, there are many factors we know are...
What criteria is needed in relapsed/refractory B-cell ALL to choose CAR-T therapy over conventional stem cell transplant as destination therapy?
Currently, there are no standard criteria used to choose CAR-T over conventional stem cell transplant as destination therapy. However, there are many factors that often push us in one direction or the other. As we learn more about outcomes after CAR-T cell therapy, there are many factors we know are...
In which situations are you comfortable with alternative dosing of ovarian suppression (e.g Lupron q3m) for premenopausal patients during adjuvant breast cancer treatment?
My first option, when feasible/practical is to use every 4-week formulation of GNRH analog ovarian suppression treatment for hormone receptor-positive breast cancer. When that frequency of treatment presents a hardship, I generally feel comfortable with using ovarian suppression using depot GNRH ana...