Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How do you treat unresectable localized desmoid tumor?
Based on the NEJM paper, I use sorafenib. Standard of care is observation unless there is pain or a medical reason to treat.
What are your top takeaways in Gyn Cancers from ASCO 2024?
ASCO 2024 was a quiet year for the gynecological cancer community without too many fireworks. For the radiation oncologists, there were very few positive studies. I will highlight a few important ones 1. Oral abstract #5504 was on “Adjuvant chemotherapy following concurrent chemoradiation (CRT) in p...
How do you manage surveillance imaging for patients with metastatic castration-resistant prostate cancer?
Outside of trials - for SOC patients, I'll usually get imaging around treatment PSA nadir (understanding some of the changes in bone may lag PSA responses). Then, will re-image based on consistent/significant PSA rise or new symptoms. I try to adhere to working group radiographic criteria for SOC pa...
Given the HELEN-006 trial results, under what circumstances, if any, would you consider de-escalated neoadjuvant therapy in HER2-positive breast cancer?
The phase III HELEN-006 trial of abraxane/trastuzumab/pertuzumab (AHP) vs TCHP was first presented with positive results at SABCS 2023, then at AACR 2024, and finally published fully in January 2025 in the Lancet. To summarize the findings, the Lancet 2025 article documented that in this randomized ...
How do you incorporate ctDNA in the management of metastatic breast cancer?
I do use ctDNA molecular profiling assays to detect actionable mutations or for trial matching fairly regularly in my metastatic patients. As for ctDNA tracking tests like Signatera, I would consider their use mainly when routine in-house tumor markers like CA15-3, 27-29, CEA do not correlate well w...
Would you use new DOAC loading dose or start with maintenance dosing for a stable patient on existing DOAC who needs to switch brand due to insurance/formulary reasons?
For some drugs, you need to do a loading dose to get the drugs to therapeutic levels. However, with DOACs, a loading dose is used at the time of VTE diagnosis and therapy initiation to jump start the anticoagulant effect when the clot burden is the highest. Thus, if you are switching from another fu...
Would you use new DOAC loading dose or start with maintenance dosing for a stable patient on existing DOAC who needs to switch brand due to insurance/formulary reasons?
For some drugs, you need to do a loading dose to get the drugs to therapeutic levels. However, with DOACs, a loading dose is used at the time of VTE diagnosis and therapy initiation to jump start the anticoagulant effect when the clot burden is the highest. Thus, if you are switching from another fu...
What is your preferred subsequent treatment in patients with metastatic bladder cancer with progression on pembrolizumab/enfortumab?
Given the fundamental change associated with bringing 2 agents, previously approved for salvage therapy after chemotherapy for metastatic urothelial cancer, forward to first line treatment has left practitioners wondering what the correct sequence of therapy should now be in salvage. This will likel...
Would you consider TPO agonists for thrombocytopenia from low risk MDS?
There are randomized data supporting the use of TPO agonists in low-risk MDS with thrombocytopenia. A phase II study of eltrombopag vs placebo demonstrated a platelet response in ~40% of patients treated with eltrombopag and no increased risk of disease progression/AML evolution between the eltrombo...
How was treatment response assessed on the PROSPECT trial?
Dr. Harvey reached out to his colleague, Dr. Marc Gollub, director of radiology at Memorial Sloan Kettering with expertise in gastrointestinal imaging (and who was the radiologist who collaborated on PROSPECT), for his thoughts on this question. Here is his answer: I had to “create” a non-volum...