Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How do you treat MAS in patients with systemic JIA or AOSD with HLA-DRB1*15 alleles given risk for DRESS hypersensitivity to IL1 or IL6 inhibitor therapy?
Tough question. HLA-DRB1*15 is pretty common, and it may be a risk allele for lung disease. I, and many others, are not convinced, however, the lung disease represents DRESS, nor that a range of biologics are the etiology of the lung disease. One of my most recent sJIA patients presented with high e...
For a patient with a metastatic solid tumor in remission on a checkpoint inhibitor who also has R/R multiple myeloma, would you feel comfortable with a bispecific T-cell engager antibody?
The short history of checkpoint inhibitors in myeloma has raised some issues with their use. Of course, in this scenario, they are being employed for other cancers, but they may be instructive nonetheless, especially as it pertains to combination strategies. IMiDs and checkpoint inhibitors don't se...
Is post-mastectomy chest wall radiotherapy indicated for DCIS with very close (<1 mm) or positive margins?
As with most clinical situations with limited data, individualized decision-making is key. Based on small series, I do not generally offer RT post mastectomy for DCIS if it is close. If it is clearly involved after reviewing with the pathologist, I would discuss with the surgeon and patient taking i...
Do you recommend CDK4/6 inhibitor, radiotherapy, or both following surgery for a pathologic fracture from HR+ breast cancer?
The goal of therapy is to help control pain and enhance healing. Post-op RT is routine with the most common dose used by us being 20 Gy in 5. It’s reasonable to do with concurrent CDK4/6 inhibitor.https://www.ncbi.nlm.nih.gov/pubmed/31360799
Would you consider using sotorasib first line in patient with metastatic KRAS G12C NSCLC who declines chemotherapy?
This would be outside the scope of available data and current FDA approval. Both CodeBreaK100 and CodeBreaK 200 (presented at ESMO) included only patients previously treated with either chemotherapy, immunotherapy, or both. I would generally stick to standard first line options for these patients, e...
Do you ever consider intermittent ADT for metastatic prostate cancer?
In general, I recommend continuous ADT for men with metastatic disease based on the OS difference from the Intergroup 0162 trial. I do agree, however, that this trial was a noninferiority design and the difference is not large, therefore in men with very limited disease who display intolerance to AD...
Why are patients getting enzalutamide s/p prostatectomy not candidates for salvage radiation therapy?
Although there have been other efforts to profile the role of enzalutamide (e.g., SALV-ENZA, Tran et al., PMID 36367998) or other second generation androgen axis inhibitors (e.g., FORMULA-509) in conjunction with salvage RT, EMBARK (Freedland et al., PMID 38320501) was designed to test the efficacy ...
Is the increase in RFS seen with adjuvant atezo/bev in IMbrave050 enough to change practice in resected HCC?
The IMbrave050 showed that the combination atezolizumab/bevacizumab improved recurrence free survival in high risk resected HCC patients with RFS 78% vs 65% at 12 months, HR 0.72 (95% CI 0.56, 0.93), this tapered off at approximately 24 months. This suggests that the combination delayed recurrence a...
What is your strategy for managing immunosuppression in patients with a kidney transplant who develop metastatic cancer?
This is a difficult situation. I presume this question refers to cancers for which there is no option of cure. We always discuss the goals of care and review with the patient and their treating oncologist what the prognosis might be. If chemotherapy or check-point inhibitor treatment is planned we ...
Would you offer adjuvant hormonal therapy for premenopausal woman with positive margin HR+ DCIS after a bilateral mastectomy?
Preventive endocrine therapy, with tamoxifen for premenopausal women, should be offered after breast conserving surgery (BCS) and radiation (RT), as it decreases the risk of future events in the ipsilateral breast and also offers preventive benefit in the contralateral breast. Preventive endocrine t...