Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
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...
How are you treating MSI-H CRC in a liver transplant recipient on tacrolimus & sirolimus?
This is an important question; however, our experience in the metastatic colorectal cancer (mCRC) setting remains very limited. This patient underwent liver transplantation three years ago and has since developed dMMR/MSI-H metastatic colorectal cancer. The patient is currently receiving tacrolimus ...
How does your management of stomatitis from Dato-DXd compare to your approach for stomatitis from other cancer-directed treatments?
By and large, the treatment is similar, though dexamethasone rinses are essential (10 mL oral solution, 4 times a day). Patients should swish/gargle the steroid solution for 1-2 minutes, then spit it out. Food and drink should be avoided for 30 minutes afterward. Similarly, patients should avoid cau...
For patients with newly diagnosed unmutated CLL how will you decide between BTKi alone vs Ven/BTKi vs Ven/Obin vs Ven/Obin/Acalabrutinib?
My usual practice has been Ven Obin for most patients, even unmutated, but if they have bulky nodes and are young/fit, I am now adding acala to that and giving the 3-drug regimen. Continuous BTKi in my practice is mostly reserved for the older or less fit patients, or those who really, really don’t ...
For patients with newly diagnosed unmutated CLL how will you decide between BTKi alone vs Ven/BTKi vs Ven/Obin vs Ven/Obin/Acalabrutinib?
My usual practice has been Ven Obin for most patients, even unmutated, but if they have bulky nodes and are young/fit, I am now adding acala to that and giving the 3-drug regimen. Continuous BTKi in my practice is mostly reserved for the older or less fit patients, or those who really, really don’t ...
How, if at all, are you employing ctDNA in the management of patients with colon cancer?
This is a great question and one that has been a huge point of extensive discussion with a lot of my patients and colleagues. I think there is a lot of variation at this time amongst providers in the implementation of this test, but I will provide my general approach and welcome other approaches as ...
What is your approach to VTE prophylaxis in hospitalized patients who are already on DAPT?
DAPT by itself is not considered DVT prophylaxis in patients at high risk of DVT. However, LMWH at prophylactic doses can increase the need for transfusions in patients on DAPT, without decreasing VTE rates. In general, I consider patients individually: Do they still need DAPT? With discontinuity o...