Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Would you use upfront atezo/bev in a patient with HCC and untreated hepatitis?
In the case of a patient with untreated chronic hepatitis C, I would offer upfront atezo/bev, as long as hepatic function is appropriate. At our center, hepatitis C treatment is generally not offered to patients with advanced HCC. Interestingly, only 21% of patients treated with atezolizumab/bevaciz...
Do you recommend frontline bevacizumab with carbo/taxol in patients with advanced epithelial ovarian and BRCA mutation who will be receiving olaparib maintenance?
As shown in GOG-218, there is no apparent benefit to using concurrent bevacizumab with paclitaxel and carboplatin in the first-line setting, if this drug is not then continued during maintenance therapy. Our approach is to obtain genetic testing in patients with epithelial ovarian cancer as soon as ...
How would you approach the management of a patient with metastatic non‑small cell lung cancer who previously received whole brain radiation therapy three years ago and now presents with 20 new brain metastases on MRI?
How aggressive I would be depends on KPS (which sounds to be good in this case), the patient's extracranial disease status (which sounds to be controlled on current therapy in this case), plans from a systemic therapy perspective (will the patient continue on the same therapy and what was the patien...
What are your top takeaways in Thoracic Cancers from ASCO 2025?
More presentations that were interesting for the future, than immediately impactful in thoracic oncology this year at the ASCO meeting. Immediately impactful: 8006 and 8008 – Both in SCLC. 8006- IMforte trial suggesting improvement in survival with the addition of maintenance lurbinectedin to atezo...
When will you choose Tarlatamab over an alternative systemic therapy (e.g. lurbinectedin, topotecan) for relapsed ES SCLC?
I generally offer tarlatamab as a second line option in small cell lung cancer patients who are fit (ECOG 0-1), can logistically accommodate the hospitalization and infusion schedule, have low-risk factors for ICANS, and have treated brain metastases. I would consider a platinum etoposide rechalleng...
Would you consider delaying tarlatamab initiation in a patient with ES SCLC who recently completed RT for CNS disease, given the concern for immune effector cell-associated neurotoxicity syndrome (ICANS)?
I would not delay beyond what we already do for other systemic treatments. We tend to wait at least a week or more after whole brain RT and systemic therapy of any nature. I do not think this is any different.
Are you using maintenance lurbinectedin with immunotherapy in the first-line treatment of extensive stage small cell lung cancer?
Yes. I am encouraged by the recent IMforte data demonstrating both PFS and OS benefit with the addition of maintenance lurbinectedin (Paz-Ares, Lancet 2025). Landmark PFS at 6 months approximately doubled (42% vs 19%) and OS at 1 year was 56% vs 44% with atezo+lurbi vs atezo alone. The rate of attri...
What are the main practical factors to consider when using bispecific antibody therapy (Tarlatamab) for extensive-stage small cell lung cancer?
The overall survival (OS) for patients with relapsed refractory small cell lung cancer is poor with an estimated OS of 8-9 months. Prior to DLL3 bispecifics, the 2nd line therapeutic options included topotecan and lurbinectidin. Topotecan always had an unusual positioning as a second line agent. The...
Would you continue tarlatamab in CNS-only progression of small cell cancer if there is no systemic disease?
I would absolutely continue tarlatamab in this scenario. While there is evidence of at least some activity of tarlatamab in the CNS (e.g., Zhang et al., PMID 40126456), the effect can be transient, suggesting that intra- and extracranial discrepancy is possible/probable. I would handle isolated, oli...
How do you approach Tarlatamab use in an elderly patient with relapsed ES SCLC?
Age is relative and there are numerous studies showing that well-performing elderly patients can tolerate systemic therapy to small cell lung cancer. That being said, I first assess whether additional cancer therapy is within the goals of care for each individual patient. While the outcomes for DLL3...