Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
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?
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...
Would you consider chemoimmunotherapy (CP-Pembro-AC) in triple negative breast cancer if tumor is not palpable on physical exam?
KN522 regimen is approved for cT2 or greater (tumor >2cm) regardless of nodal involvement or cT1c with nodal involvement. The tumor size can be determined by a physical exam or radiologic assessment or both. Therefore, it is perfectly fine to use KN522 regimen if the tumor is not palpable as long as...
How would you manage a patient who develops acute stroke during neoadjuvant chemotherapy with KEYNOTE-522 for Stage III triple negative breast cancer?
I will try to provide some data for discussion, but also welcome comments from other experts and opinions. I'm assuming this is a younger patient without known risk factors and that an assessment for things like A. Fib, PFO, and DVT have been performed.Chemotherapy has long been associated with thro...
How would you manage a patient who develops acute stroke during neoadjuvant chemotherapy with KEYNOTE-522 for Stage III triple negative breast cancer?
I will try to provide some data for discussion, but also welcome comments from other experts and opinions. I'm assuming this is a younger patient without known risk factors and that an assessment for things like A. Fib, PFO, and DVT have been performed.Chemotherapy has long been associated with thro...