Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How would you treat an older patient with B symptoms and biopsy consistent with grade 3 follicular lymphoma but noted to have a PET scan with SUV readings of > 20?
If an adequate biopsy was performed of the most active (high SUV) mass/node and results as follicular grade 3 A, then can treat as you would a follicular lymphoma with BR. I have seen high SUVs with follicular lymphoma. Mir et al., PMID 31961926However, if it is follicular grade 3 B or has high Ki67...
How would you treat an older patient with B symptoms and biopsy consistent with grade 3 follicular lymphoma but noted to have a PET scan with SUV readings of > 20?
If an adequate biopsy was performed of the most active (high SUV) mass/node and results as follicular grade 3 A, then can treat as you would a follicular lymphoma with BR. I have seen high SUVs with follicular lymphoma. Mir et al., PMID 31961926However, if it is follicular grade 3 B or has high Ki67...
When, if ever, would you consider use of nivo/ipi for favorable risk metastatic ccRCC?
I do think about nivo/ipi for a subset of patients with favorable risk disease -- usually younger patients who are shooting for a complete response. In the favorable risk subset of patients in CheckMate 214, the complete responses are higher than even in the intermediate-poor risk. Patients who have...
What are your top takeaways in GU Cancers from ASCO 2025?
Here are the top 3 prostate cancer studies: AMPLITUDE. LBA5006: Attard and colleagues show that the PARP inhibitor niraparib plus abiraterone/prednisone delayed rPFS in men with mHSPC (HR 0.63, p = 0.0001), meaning this is the first ARPI/PARPI successful combination in this hormone-sensitive HRRm se...
What is your first line of therapy for refractory Hodgkin lymphoma in an AYA patient?
Our first approach in this setting is second line chemotherapy with the intention to achieve a complete metabolic remission (by PET) and then an autologous stem cell transplant. Our approach to the transplant includes total lymphoid irradiation followed by a conditioning regimen of Cyclophosphamide,...
What is your first line of therapy for refractory Hodgkin lymphoma in an AYA patient?
Our first approach in this setting is second line chemotherapy with the intention to achieve a complete metabolic remission (by PET) and then an autologous stem cell transplant. Our approach to the transplant includes total lymphoid irradiation followed by a conditioning regimen of Cyclophosphamide,...
What is your approach to the adjuvant treatment of early-stage mixed-histology endometrial cancer with a significant clear-cell component?
Clear cell carcinomas are under-represented in most clinical trials and hence, clear evidence-based recommendations are difficult to make. Even a small percentage of clear cell is sufficient to label these as “high grade”. The recently published ASTRO guidelines mention that chemotherapy may not ben...
Is switching to carboplatin/gemcitabine reasonable for a patient with muscle invasive bladder CA who proceeded to cystectomy first and had AKI with cisplatin/gemcitabine prohibiting further cisplatin?
There is not a role for gemcitabine and carboplatin in the adjuvant setting in patients with muscle invasive bladder cancer. Based on CheckMate 274 (Bajorin et al., PMID 34077643), in patients with MIBC with a high risk of recurrence (pT3, pT4a, or pN+ and not eligible for or declined adjuvant cispl...
How would you advise medical oncologists who recommend checkpoint inhibitors for a patient with baseline type 1 diabetes?
T1DM means near-complete beta-cell deficiency. These patients aren’t making enough insulin to impact blood glucose control. We always treat the cancer first, with the most appropriate medications, and worry about the diabetes later. We even advise oncologists to continue ICIs after a patient develop...
How would you treat a patient with metastatic NSCLC, adenocarcinoma subtype with BRAF V600K mutation, PD-L1 >50% with progression on 1st line chemo-immunotherapy?
Will treat with BRAFi/MEKi combination. We extrapolate data from experience in melanoma, given BRAF V600 mutation occurs much less commonly in NSCLC. BRAF V600K is another class I activating exon 15 BRAF mutation, which occurs in about 10% of all BRAF-mutated melanoma, and is associated with worse p...