Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How do you manage maintenance for BRAF V600E-mutated metastatic colon cancer responding to FOLFOX + encorafenib + cetuximab (BREAKWATER) in the first line?
I would treat with mFOLFOX plus encorafenib and cetuximab for 8-12 cycles, provided responding/tolerating, and then maintain on encorafenib and cetuximab without the 5-FU till progression/intolerance.
Do you routinely check serum phosphorus levels after IV iron therapy?
Only before and after FCM. I hold subsequent doses if phosphorus low. There is no need to monitor with the other formulations. For people needing multiple doses of IV iron (IBD, bariatric surgery, heavy uterine bleeding, angiodysplasia), I avoid FCM.
Do you recommend vitamin C supplementation with PO iron in patients with iron deficiency?
Vitamin C supplementation is unnecessary. Taking the iron with a glass of orange juice away from food and especially coffee optimizes absorption. That being said vitamin C does no harm. See vonSiebenthal et al eClinical Works 2023 (Lancet publication), Benson et al, Lancet Haem 2025 or Auerbach et a...
When would you use AVD + brentuximab instead of ABVD for newly diagnosed stage 3 or 4 Hodgkin lymphoma?
By reducing the risk of primary treatment failure from 23% to 18%, the ECHELON-1 study demonstrated that compared to ABVD, AVD + brentuximab vedotin reduces the risk of primary treatment failure by about 25% for patients with advanced-stage classic Hodgkin lymphoma. If given with prophylactic G-CSF,...
When would you use AVD + brentuximab instead of ABVD for newly diagnosed stage 3 or 4 Hodgkin lymphoma?
By reducing the risk of primary treatment failure from 23% to 18%, the ECHELON-1 study demonstrated that compared to ABVD, AVD + brentuximab vedotin reduces the risk of primary treatment failure by about 25% for patients with advanced-stage classic Hodgkin lymphoma. If given with prophylactic G-CSF,...
Would you recommend adding a mineralocorticoid receptor antagonist or endothelin receptor antagonist for a patient with bevacizumab-induced proteinuria who is already on an ACEi or ARB?
Unfortunately, we have no data to guide the choice of anti-proteinuric agents in this particular setting. We do have biological plausibility for antagonizing the endothelin pathway, as we know that vascular endothelial growth factor inhibition results in upregulation of endothelin-1, and the resulta...
What are your top takeaways in Radiation Oncology from SABCS 2025?
Several significant studies were presented at San Antonio this year. I will focus on the three most important abstracts reporting new data from studies of local-regional therapy. (The 10-year update of the BIG 3-07-TROG 07.01 trial comparing hypofractionated and conventional fractionation and the us...
How would you treat a patient with end-stage renal disease, a germline BRCA1 mutation, and pT1c pN0 TNBC s/p mastectomy?
To better address this question, I have consulted our phenomenal specialty pharmacist at our breast cancer program, Dr. Michael Berger. Based on the information he provided, doxorubicin and paclitaxel can be given at full doses in patients with end-stage renal disease (ESRD) as these agents are meta...
Would you consider immunotherapy in high-risk resectable MSI-H colorectal cancer?
Immunotherapy demonstrated great activity in treating metastatic MSI-H colorectal cancer (CheckMate 142 study, KEYNOTE-177 study, etc). There are now several small studies showing the activity of immunotherapy in early stage or locally advanced colorectal cancer. The NICHE study enrolled 40 patients...
What non-variceal EGD findings, if any, deter you from using atezo/bev in patients with advanced HCC?
I would discuss the severity and risk of bleeding with the endoscopy team and start beta blockers as indicated before starting anti-angiogenesis therapy.