Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Is there a subset of breast cancer patients who may benefit more from GnRH analogs for fertility preservation compared to others?
In the prior research and the meta-analysis conducted by Lambertini et al., use of GnRH was not associated with any group of premenopausal women doing worse from a disease standpoint. Further we now know from the Suppression of Ovarian Function with Triptorelin Trial (SOFT) that adding ovarian suppr...
Are there any special considerations for treatment of metastatic acral melanoma?
In general, acral melanoma is a higher-risk disease. There are higher rates of acquired and primary resistance. Given this, I favor ipi-nivo since the overall risk is higher and response rates to single-agent PD-1 or nivo-rela tend to be lower. Emerging data suggest TIL therapy can work reasonably w...
How do you monitor for pulmonary toxicity for patients on trastuzumab deruxtecan?
Eligibility criteria for T-DXd trials were based on clinical history and not on objective findings such as PFTs or radiographic criteria. Therefore, risk for factors for T-DXd-related ILD or other pulmonary toxicity are not at all clear, although they may emerge with larger pooled safety analyses an...
In your practice, what premedications do you use for subcutaneous daratumumab?
We administer the following pre-infusion medications 1 hour to 3 hours before the first 4 SQ infusions, and then we drop all premedications (except for dexamethasone) thereafter: Dexamethasone 20-40 mg Acetaminophen 650 mg Diphenhydramine 25 mg Montelukast 10 mg [this is not in the package insert b...
In your practice, what premedications do you use for subcutaneous daratumumab?
We administer the following pre-infusion medications 1 hour to 3 hours before the first 4 SQ infusions, and then we drop all premedications (except for dexamethasone) thereafter: Dexamethasone 20-40 mg Acetaminophen 650 mg Diphenhydramine 25 mg Montelukast 10 mg [this is not in the package insert b...
Do you wait to treat small asymptomatic brain metastases until they reach a certain size?
I typically treat all lesions on MRI that are found to be concerning for brain metastases. This is after a discussion with our neuroradiologist colleagues. If there is uncertainty that a small lesion may not be a brain metastasis, then I will elect to follow with a surveillance MRI and treat in the ...
Would you consider neoadjuvant immunotherapy prior to radiation for a locally advanced skin squamous cell carcinoma?
While the definitive trials are yet outstanding and enrollment in NRG HN0014 (NCT06568172) should be encouraged where it is open, the present indications for using cemiplimab should follow its principal indication, unresectable cutaneous squamous cell cancer, a minority of cases at 5%. Practically s...
Would you give adjuvant pembrolizumab in a MSI-H oligometastatic colorectal cancer status-post resection that responded to neoadjuvant ICI?
Only <5% of metastatic colorectal cancer is mismatch repair deficient (dMMR) or microsatellite instability-High (MSI-H). However, it is such an important predictive biomarker for quick, sometimes dramatic, and durable response to immunotherapy as seen in the first line studies (CheckMate 142, KEYNOT...
In which patients will you consider a shorter course of adjuvant Herceptin?
At this point, I would not treat any patients with short term trastuzumab. The Short-Her study had very wide confidence intervals for non-inferiority, and there was a numerically superior 2.2% improvement in DFS in the long (standard) trastuzumab arm. Additionally, in the patients with the worst pro...
What factors would make you choose IPI3/NIVO1 frontline for advanced unresectable and metastatic HCC based on CheckMate 9DW?
Great question! CheckMate 9DW with the combination IPI3/NIVO1 compared to sorafenib/lenvatinib (85% were lenvatinib in the control arm) significantly improved OS (23.7 months vs 20.6 months, HR 0.79, P-value 0.018), response 36% vs 13% (P-value <0.0001). Based on these data, it received FDA approval...