Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
In patients with CML who are receiving 1st line TKI with good molecular response, are you continuing therapy or switching to asciminib based on the ASC4FIRST data?
For a CML patient with optimal response and excellent tolerability to their current TKI, there should not be impetus to switch to asciminib. For patients with less than optimal response, diminished quality of life, and in certain settings of adverse effects from current therapy, consideration of TKI...
How would you treat a post-menopausal woman with recurrent breast cancer, T1bN0 HR+ (ER/PR > 90%), HER2- s/p lumpectomy and adjuvant RT with low oncotype of 6?
The question does not provide the details of recurrence as to whether this is a locoregional breast recurrence, with or without lymph node or chest wall involvement. Ipsilateral or contralateral or second primary? Prior lumpectomy margins, prior type, and extent of radiation therapy? Time to recurre...
What factors do you take into account when deciding which gene expression assay to utilize when making adjuvant treatment decisions in patients with non-metastatic breast cancer?
Oncotype DX has been validated in multiple large prospective trials and has demonstrated predictive value, while MammaPrint has not been validated to be predictive for chemotherapy benefit but only identifies low-risk biology. Oncotype DX has been validated in node-negative and 1–3 node-positive dis...
How do you approach second-line options for relapsed myeloma after front-line quadruplet therapy?
It depends on the patient's case. In the setting of high-risk disease, whether clinically high risk or with HRC would prefer to use CAR-T in the second line. Currently, SoC allows for bispecific use beyond the 4th line, therefore would use triplet such as DPd (APOLLO) or IsaPD (ICARIA) second line f...
How do you approach second-line options for relapsed myeloma after front-line quadruplet therapy?
It depends on the patient's case. In the setting of high-risk disease, whether clinically high risk or with HRC would prefer to use CAR-T in the second line. Currently, SoC allows for bispecific use beyond the 4th line, therefore would use triplet such as DPd (APOLLO) or IsaPD (ICARIA) second line f...
How would you approach adjuvant endocrine therapy after excision of a hormone positive recurrence after mastectomy who finished 5 years of aromatase inhibitor for the same primary tumor in the context of NATALEE and MonarchE trials?
The key question is whether this is an endocrine-sensitive or endocrine-resistant disease. If this recurrence happened after discontinuation of endocrine therapy, then most likely it is because of withdrawing therapy that was effectively suppressing the disease. This is not an uncommon scenario, and...
How do you approach a patient with stage IIA non-small cell lung cancer who received SBRT?
Well, this is a very challenging question that certainly has come up in discussions at times over the years and I could conclude with a very simple answer: No or could offer a more twisted answer arriving at the same response- just for the fun of it, let’s do the latter.So how would we, as a multidi...
Would you offer immunotherapy after chemoradiotherapy for Stage III lung cancer given results of PACIFIC Trial?
In light of the comments by Professor Vansteenkinste comparing the ESMO 2017 plenary session incorporating the PACIFIC study results as a “tsunami” in the footsteps of last year’s ESMO lung cancer “earthquake” presentations, an appropriate title to this question might be- should we let the” floodgat...
How do you decide the dose of aspirin to use in MPN patients?
The standard dose for aspirin in the USA for MPN patients is aspirin 81 mg daily. I sometimes use 81 mg BID for patients with significant CV comorbidities. Some patients with headaches or microcirculatory symptoms may improve symptomatically with BID aspirin. Lastly, patients with erythromelalgia wi...
Is there a role for bevacizimab (IV or IA) for steroid refractory radionecrosis for AVM?
Radiation necrosis (RN) following SRS can occur at variable intervals of time following treatment, usually occurring 9-18 months later. The preferred first line of approach is usually steroids, as done in this case. I usually look at the MRI-Flair images and determine the dose of dexamethasone depen...