Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
What is your preferred treatment option after tarlatamab for patients with ES-SCLC?
The preferred treatment is a clinical trial - and there are several promising agents in development for SCLC, including a number of antibody-drug conjugates targeting B7-H3, Trop2, SEZ6, and DLL3. Outside of a trial, our treatment algorithms focus on chemotherapy, and my preferred agent here is lurb...
What initial systemic therapy would you offer a patient with metastatic colon cancer with BRAF V600E mutation, MSS, who is not an oxaliplatin candidate?
In patients with BRAF-V600E mutant colon cancer who are not candidates for oxaliplatin, replacing the chemo backbone with FOLFIRI is what I’ve done for a few patients without any clinical or insurance issues.This is based on the BREAKWATER study, which, of note, had a FOLFIRI/EC arm - results report...
What second line therapy do you use for metastatic thymoma that recurs following CAP?
Multiple agents can be used to treat recurrent thymoma that requires systemic therapy. Thymoma can be indolent and may not require systemic therapy for some time. Radiation therapy can also postpone the need for systemic treatment in selective cases. Therefore, in some cases, observation is appropri...
Do you take into account ALK fusion variants in your practice for deciding treatment for NSCLC?
EML4-ALK v3 subtypes and TP53 co-mutations tend to be associated with shorter overall survival in patients, and while we take note of these molecular changes, they have not yet been affected by the selection of frontline therapy. I pay attention to ALK mutations, specifically the G1202R mutation, wh...
What time frame, number of PSAs, and calculator do you use for calculating PSA doubling times?
I typically use only values of 0.10 ng/mL or greater, and at least 3 separate PSA values that are at least 3 weeks apart from each other. The greater the number of PSA values, the more accurate the PSADT calculation will be. I like to use the MSKCC calculator: Prostate Cancer Nomograms: PSA Doubling...
Would you recommend radiation or chemoradiation in a patient with cholangiocarcinoma s/p surgery and adjuvant treatment with single hepatic metastasis 3 years later?
Challenging case and worthy of tumor board discussion. I would likely start systemic therapy, and if response, consider regional therapy with resection or SBRT, assuming the hepatic function is adequate (keep in mind, TARE can cause liver disease). I have one patient in a similar situation, now > 5 ...
Should capecitabine be administered at a specific time prior to RT in pre-op chemoradiation treatment for rectal cancer?
We looked at this question and published our analysis in 2007. We looked at the timing of administration and radiation delivery. The dosing of capecitabine was standardized, and the radiation timing was random. The 2-year local control, distant control, and disease-free survival were nearly identica...
What factors do you use to decide between trastuzumab-deruxtecan and sacituzumab govitecan in HER2-low metastatic breast cancer?
Updated answer - 11/26/2024There is currently limited data to guide the efficacy of trastuzumab deruxtecan (T-DXd) after progression on sacituzumab or vice versa. Since both drugs have a topoisomerase 1 inhibitor payload, cancers resistant to topoisomerase 1 inhibitors may be resistant to both drugs...
What are the factors that you would consider for the use of ESA in patients with anemia of CKD with a history of stroke or TIA?
Large clinical trials of ESA have indicated increased stroke risk with these medications with TREAT reporting the highest stroke incidence. In this study, "baseline history of cerebrovascular disease was a strong predictor of experiencing a stroke during follow-up; patients with a history of stroke ...
Would you recommend adjuvant chemotherapy for a Stage II colon cancer patient who has negative ctDNA but presented with obstruction?
I often tell my patients that, where the field of liquid biopsy is at present, we have not too many concerns about the positive ctDNA results. It’s the negative ctDNA results that one has to be careful with.In general, if there’s a strong clinical reason to give adjuvant, I don’t rely on ctDNA to ch...