Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
What are your top takeaways in Thoracic Cancers from ASCO 2023?
Always so hard to pick a top 3 as luckily each ASCO provides us with a broad spectrum of significant advances in our field but if pressed against the wall, I might pick below 3: The first is a double dip choice I admit matching ADAURA with KN789. Of course, you need to be living in a cave not to be ...
Is there any evidence that sotorasib is effective in KRAS-driven tumors beyond KRAS G12C?
The short answer is no, sotorasib does not have efficacy in KRAS mutant tumors beyond KRAS G12C. KRAS activates downstream signaling by actively cycling from GTP to GDP, and exists in both GTP and GDP states. The cysteine residue at the covalent binding pocket under switch II in the inactive GDP sta...
Are there best practices for managing or mitigating toxicity from sotorasib such as hyperbilirubinemia or edema?
Personally, I think it is important to monitor closely so that any adverse events could be detected early and acted upon quickly. Based on the package insert of sotorasib (lumakras_pi_hcp_english.pdf), liver function tests should be monitored every 3 weeks for the first 3 months of treatment then on...
How do you approach treatment sequencing in KRAS G12C NSCLC?
Sequencing is an excellent question that will require a little more time to be answered. There are currently multiple ongoing trials in this space but at the current moment, the approval of sotorasib is in the second line space and I would not use KRAS inhibitors as first line off study. That being ...
What are your treatment considerations for a patient with stage IVb NSCLC who is KRAS G12C mutated and PD-L1 high (>50%)?
Assuming that this is in the treatment naïve scenario, we have a lot of options in this case. The patient could be considered single agent immunotherapy or chemo-immunotherapy or clinical trials for KRAS G12C. While we need more prospective data on this topic, I still look at the co-mutations (i.e.,...
Do you recommend holding a KRAS inhibitor during palliative radiotherapy?
I have no personal experience or anecdotes and know of no current data or literature that would address this very specific question and this may be due to the limited experience on the potential interaction of this class of drugs and radiotherapy, since this drug is relatively new.This class of drug...
What are your top takeaways in Thoracic Cancers from ASCO 2022?
1. Abst 8502 - Quality metrics and survival after lung cancer surgery: More efficient work-ups and consistently high quality resections will likely do more to improve lung cancer survival than any adjuvant or neo-adjuvant therapy we can come up with. This is low-hanging, low-cost fruit. 2. Abst 9007...
Is there any role for re-biopsy and NGS for patients with NSCLC and KRAS G12C at time of progression after first line therapy before starting sotorasib, or after progression on sotorasib?
This is a great question and one that will come up more frequently. There clearly is a role for biopsy at the time of progression on targeted therapies in other driver alterations in NSCLC, and in limited data; to date, we know that occasionally there are resistance mechanisms to KRAS inhibitors tha...
What is the preferred second line, systemic therapy for NSCLC patients following first line chemoimmunotherapy?
This is as usual a quite complex question, and for a sophisticated audience such as theMednet readers, I always want to provide a nuanced answer; so here is what my preferred second line systemic therapy currently is:None.None.Still none…Indeed, now that chemo/immunotherapy has become the de facto s...
How would you approach the staging and treatment of extranodal marginal zone lymphoma of left and right lacrimal gland?
This entity is described in literature as "ocular adnexal lymphoma". I usually screen those patients for Chlamydia infection and would empirically consider a 3-week course of doxycycline especially if the disease is indolent behaving clinically and there is prior serologic evidence of Chlamydia infe...