Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
What are your top takeaways in Radiation Oncology from SABCS 2024?
Wine regions have good years and bad years. This year's vintage from San Antonio was exceptionally fine, with oral presentations of several important, highly anticipated trials. The second and third of the studies I will discuss were also published on the day of the oral presentation.1. GS2-03: Kunk...
Would you recommend enfortumab vedotin plus pembrolizumab for localized advanced non-invasive urothelial carcinoma of the renal pelvis?
Urothelial carcinoma of the renal pelvis is always challenging to stage and is often understaged. However, it would be difficult to justify systemic therapy with EV + P for non-invasive disease on the path. This patient will likely need upfront RNU followed by adjuvant therapy based on pathological ...
What is your approach to cancer patients who inquire about alternative or complementary treatments?
It depends a little bit on what specifically they want to use, and if they are truly investigating alternative medicine or complementary medicine. For people seeking full alternative medicine without any conventional treatment, I tell them that a research study showed that people who pursued the alt...
What is your approach to cancer patients who inquire about alternative or complementary treatments?
It depends a little bit on what specifically they want to use, and if they are truly investigating alternative medicine or complementary medicine. For people seeking full alternative medicine without any conventional treatment, I tell them that a research study showed that people who pursued the alt...
Would you extend pembrolizumab for over 2 years in a patient with MSI-H pancreatic ductal adenocarcinoma with now-stable disease?
I usually don't, but admittedly, this is a "data-free zone" in the pancreas. I would just stop and watch carefully with scans and tumor markers and have a low threshold to resume or biopsy if it looks like there is progression.
How do you monitor for cardiac toxicity in patients taking osimertinib?
There are multiple studies that have explored the issue of cardiotoxicity from osimertinib. A large single-center retrospective observational cohort series from Taiwan, (n=401) compared a matched cohort of patients treated with osimertinib (n=253) to those treated with other EGFR TKIs (n=195) and fo...
When would you consider Amivantamab + Lazertinib combo for first line in EGFR mutated metastatic NSCLC?
I would certainly consider amivantamab + lazertinib combination treatment in the first-line setting for metastatic EGFR-mutated NSCLC. This is based on the data from the MARIPOSA phase III trial. This trial noted improved survival outcomes in the frontline setting for patients with EGFR exon 19 dele...
What systemic therapy would you use in T3N1M1 MMR proficient rectal cancer with solitary liver lesion when going for curative intent (chemo>short course RT> resection of primary and liver met)?
Hi,I think this is an important question. For resectable disease, most data we have is from the EORTC 40983 trial in which FOLFOX was used. For borderline resectable, you could consider FOLFOXIRI based on the OLIVIA trial. That being said, obtaining molecular profiling for this patient is key which ...
Would you consider using ensartinib in patients with ALK-positive NSCLC who have progressed on alectinib and lorlatinib?
I've written about this previously (https://www.themednet.org/question/23471). The question invokes a conceptual model of cancer therapy sequencing from the chemotherapy era, where it was the norm to go through lines of therapy with diminishing returns (e.g., platinum doublet, then docetaxel, then g...
Do you recommend re-excision of a unifocal positive anterior margin at skin after lumpectomy in a patient with otherwise low risk breast cancer features?
There are few data on how margin location affects outcome. A group from Dundee and Perth in Scotland reported that re-excision performed for an anterior margin of less than 1 mm found residual disease in only 4% of patients who had initial excision in the subcutaneous plane, compared to 24% of patie...