Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
What is the optimal antithrombotic management, if at all, in patients with incidentally identified findings of multiple silent embolic appearing cerebral infarcts?
It is important to confirm the pattern is embolic. If unsure, input from a specialized physician (such as vascular neurology or neuro-radiology, if available) can aid in confirming the diagnosis. Various white matter findings may mimic an embolic pattern, and distinguishing between unilateral...
How do you decide when to use andexanet (ANDEXXA) for intracranial hemorrhage associated with factor Xa inhibitors?
The ANNEXA-I trial presents a mixed perspective. The data demonstrated that Andexanet is superior to standard care in reducing hematoma expansion for intracerebral hemorrhage associated with factor Xa inhibitors. This conclusion is based on an imaging-based primary endpoint, supported by previous st...
Do you have a preferred systemic agent for patients with metastatic, unresectable, functional neuroendocrine tumors, such as an insulinoma, if the goal is to get a quick response?
The management of metastatic unresectable neuroendocrine tumors depends on many factors including functionality, tumor burden, primary tumor, and SS expression. Usually, part of the management will be SSA to control hormonal secretion, however, we should be careful in patients with insulinoma. While...
Do you ever offer adjuvant chemotherapy to patients with resected stage IB non-small cell lung cancer when the tumor is less than 4cm in size?
Given the results from the BILCAP trial presented at ASCO, would you change to or initiate therapy with capecitabine for patients with biliary tract cancer in the post-operative setting?
The BILCAP study represents the first data from a large, randomized, prospective, adequately-powered trial demonstrating a survival benefit for adjuvant therapy in this difficult-to-treat and relatively rare cancer.Given that capecitabine is relatively well tolerated, I would likely change from gemc...
Would you offer zolbetuximab in a non-Asian population?
Great question. Both studies suggested a discrepancy in benefits between white and Asian patients. However, these were subgroup analyses and neither study was powered to specifically detect a significant effect in white patients. Issues like this are frequently encountered in randomized clinical tri...
What are your top takeaways in Gyn Cancers from ESMO 2024?
Ovarian CA (Immunotherapy) There has been limited success with single agent immunotherapy in ovarian cancer. Three ovarian cancer immunotherapy studies presented at ESMO 2024 are worth noting.ATHENA-COMBO: Rucaparib +/- Nivo as Maintenance in Newly Diagnosed Ovarian Cancer - ATHENA-COMBO Ph3 TrialA...
Is the phase 2 data regarding neoadjuvant cemiplimab in cutaneous squamous cell carcinoma sufficient to adopt for all patients or will you await phase 3 data?
The current data are quite compelling, but not sufficient to adopt for all patients. We need to see the long-term recurrence and survival rates from the phase II study and also perform a confirmatory phase III trial with a survival endpoint. Unless this treatment approach results in equivalent to im...
Would you offer zolbetuximab + chemotherapy in a presumed metastatic duodenal bulb adenocarcinoma with 80% Claudin18.2 expression?
I would not. Cancers of the duodenum are different and such patients were not represented in GLOW or SPOTLIGHT. In addition, zolbe is not very easy in terms of nausea and vomiting, especially in the first cycle. Would not expect more "debulking" effect from it given the absence of significant ORR be...
For which patients, if any, do you typically order additional imaging workup for staging in early-stage breast cancer?
Many studies have shown the true-positive rate of distant metastases on pretreatment imaging to be a few percent (at most) for patients with Clinical Anatomic Stage I-II cancers. The false-positive rate is much higher. Hence, such imaging should only be used when patients have suspicious symptoms or...