Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
What is your preferred formulation of parenteral iron?
The question is not simple. The formulation I use the most is ferumoxytol because four insurance carriers allow a total dose infusion of 1020 mg in 20-30 minutes. This has been published twice (Auerbach et al., PMID 21922526 and Karki and Auerbach, PMID 31155744). Otherwise, it must be given as two ...
Has the recent presentation of RADICALS-HD changed your ADT duration recommendations for patients receiving post operative radiation therapy for prostate cancer after radical prostatectomy?
The way I interpret RADICALS is that for adverse pathology meaning GS 8 and above, T3 disease or node positive who benefit from ADT would favor 24 over 6 months and probably these are patients who benefit from nodal RT also. For a favorable type prostate fossa only RT with unclear if any additional ...
Should combined brachytherapy/EBRT/ADT be the standard of care for men with high-risk prostate cancer?
The results of the ASCENDE-RT trial are obviously very encouraging and corroborate findings from single institution studies that combined brachytherapy and external beam radiotherapy in conjunction with hormonal therapy is associated with superior outcomes compared to dose escalated external beam ra...
How do your adjuvant treatment recommendations change, if at all, for clinically node positive Stage III desmoplastic melanoma?
We will assume that the diagnosis has been confirmed by an expert pathologist and that surgically adequate local excision and lymphadenectomy have been performed.One area in which adjuvant therapy of desmoplastic melanomas may differ is radiation of the primary. Local recurrence rates are considered...
Based on the IMROZ and BENEFIT data, would you recommend quadruplet therapy for non transplant eligible newly diagnosed multiple myeloma?
Excellent question - to add citations for those who missed ASCO 2024 (I did since I was on inpatient!) and would like to jump to the manuscripts: IMROZ: Isa-VRd versus VRd (Facon et al., PMID 38832972) BENEFIT/IFM 2020-05: Isa-VRd versus Isa-Rd (Leleu et al., PMID 38830994) Both trials enrolled pati...
How do you incorporate trastuzumab, pembrolizumab, and FOLFOX, as per KEYNOTE-811?
I have been thinking about this a lot recently, as the original study was based on treatment with 5FU/cisplatin or capecitabine/oxaliplatin, both of which were q3 week trials. It begs the question as to whether one should consider 5FU/cis over FOLFOX in HER2-positive patients with GEJ adenocarcinoma...
What second line treatment would you consider in patients with ES-SCLC with recurrence after front line chemo-immunotherapy?
For patients who have progression of disease while still receiving initial chemo-immunotherapy or maintenance immunotherapy, I do not continue with immunotherapy – there is no rationale for switching to another PD1/PD-L1 inhibitor nor for adding a CTLA-4 inhibitor. If, however, maintenance atezolizu...
Is there evidence for development of more severe autoimmune toxicities for young patients vs older patients on immune checkpoint inhibitors?
I am not aware of any. In my practice, I have realized that younger patients are getting more severe autoimmune toxicities like immune-related cardiomyopathy and adrenal insufficiency.
What is your approach in treatment of oligometastatic triple negative inflammatory breast cancer?
There isn't one answer partly because "oligometastatic" isn't well-defined or uniform across cases. Given the rarity of inflammatory breast cancer, we don't have a lot of prospective data to guide treatment decisions either. Some have used 5 or fewer lesions as a definition for oligometastatic disea...
In a patient with amyloidosis and abnormal liver function but child Pugh A, would you still proceed with SABR for a liver metastasis?
No great data regarding the impact of amyloidosis on liver tolerance, but if the patient was a CP Class A patient, I would feel comfortable offering SABR for a liver metastasis.