Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
In treatment naive CLL without del(17p)/TP53, will the recent interim analysis of fixed duration acalabrutinib plus venetoclax +/- obinutuzumab vs chemoimmunotherapy in the AMPLIFY trial change your practice?
The interim analysis of the AMPLIFY trial, published in the New England Journal of Medicine, presents strong evidence that could influence clinical practice for treatment-naïve chronic lymphocytic leukemia (CLL) patients without del(17p) or TP53 mutations. The AMPLIFY trial is the first phase 3 stud...
In treatment naive CLL without del(17p)/TP53, will the recent interim analysis of fixed duration acalabrutinib plus venetoclax +/- obinutuzumab vs chemoimmunotherapy in the AMPLIFY trial change your practice?
The interim analysis of the AMPLIFY trial, published in the New England Journal of Medicine, presents strong evidence that could influence clinical practice for treatment-naïve chronic lymphocytic leukemia (CLL) patients without del(17p) or TP53 mutations. The AMPLIFY trial is the first phase 3 stud...
What factors do you use when selecting which NGS platform to use for sequencing solid tumors?
QNS rates are roughly comparable between vendors such as Caris, Tempus, FoundationOne. The presence of normal blood controls can help, but is not a criterion for complete exclusion of a platform for me. Many institutions have established workflow to send tests to a certain company for certain diseas...
Would you use T-DXd as a first-line agent for a patient who developed early metastatic relapse of HER2+ urothelial cancer shortly after standard perioperative chemo/immunotherapy, over other standard non-targeted treatments?
Currently, for first-line therapy in the metastatic setting, I would recommend enfortumab vedotin in combination with pembrolizumab, with T-DXd as a potential next-line option for patients with HER2 3+ IHC. However, there is still a need to see if HER2-targeted ADCs have a role in first-line.
Would you offer adjuvant AC + pembrolizumab for a triple negative breast cancer patient whose tumor progressed on carboplatin + paclitaxel + pembrolizumab on KEYNOTE-522 and required urgent surgery (ypT3 ypN0)?
In these situations, adjuvant AC should be considered. Anthracyclines have been shown to improve outcomes in high-risk TNBC in the adjuvant setting across multiple trials. CREATE-X used adjuvant capecitabine in patients who had residual disease after neoadjuvant anthracyclines and taxanes. It wasn't...
In rectal cancer patients receiving total neoadjuvant therapy, do you prefer chemotherapy followed by long-course chemoradiation, or short-course RT followed by chemotherapy?
We now have level 1 evidence showing the superiority of a few TNT regimens over standard chemoradiation->surgery->chemotherapy for these patients. There are going to be some stage II/III patients where TNT is overtreatment (ie, may be able to avoid the chemotherapy, radiation or surgery), but that c...
How does the latency from the original melanoma diagnosis affect your approach to neoadjuvant therapy in a patient with clinically detectable stage III nodal recurrence?
Latency should not matter, as melanoma is known to exhibit this behavior. If this patient is immunotherapy-naive at the time of diagnosis of clinical stage III melanoma, then I would proceed with neoadjuvant use of immunotherapy, regardless of the time gap between diagnosis of the original melanoma ...
How do you manage critically ill poor risk mixed germ cell tumor patients presenting de novo with extensive lung metastases and severe respiratory failure?
A few things. I would make sure the patient gets early brain imaging. I usually talk to the patient and family obviously about the severity of the condition, but also that ICU/intubation/ECMO might be needed over the course of treatment 1. I usually take the 3-day EP approach stop and watch for abou...
How long do you give maintenance pemetrexed/pembrolizumab in metastatic NSCLC treated with upfront chemoimmunotherapy?
In the Keynote trials, therapy was continued for 2 years. With a median progression free survival of approximately 8 months, the number of patients who are able to continue therapy for 2 years is small. However, if a patient does stay on therapy I follow the protocol and recommend stopping therapy a...
Would you consider the use of ruxolitinib for tumor fevers and leukocytosis?
No.