Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How would you sequence PARPi vs pembrolizumab for a patient who has progressed on ARPI to mCRPC that has somatic PALB2 mutation and MSI-H?
MSI-high disease in men with mCRPC is uncommon, accounting for 3-5% of patients overall, and typically results in high TMB. MSI-high disease is usually a result of either germline MMRD (Lynch Syndrome, about 20% of MSI-high cases) or somatic MMRD (typically MSH2 or 6, MLH1, less commonly PMS2). The ...
Would you consider stopping EGFR inhibitor in EGFR mutant NSCLC on a patient who was NED for >5 years?
It's a great question! My bias would be to lean toward continuation in the absence of significant impact on QOL. Some literature is available describing the experience of long-term responders, but even then, the definition of long-term responders is up about 2-3 years, so well below the duration of ...
Is there a role for nintedanib in the management of patients with radiation-induced pulmonary fibrosis?
There is no phase III evidence I am aware of on the benefits of nintedanib in the prevention of radiation-induced pulmonary fibrosis so it is not a drug I use. There are a few case reports and some pre-clinical studies suggesting an effect. There is a small (34 patients) randomized phase II study th...
What is your approach to Myelofibrosis in Accelerated Phase (Blast percentage 10-19%) in a transplant-eligible patient?
I generally add HMA therapy to the JAK inhibitor and try to get them to transplant ASAP.
What is your approach to Myelofibrosis in Accelerated Phase (Blast percentage 10-19%) in a transplant-eligible patient?
I generally add HMA therapy to the JAK inhibitor and try to get them to transplant ASAP.
How would you approach treatment of a patient with metastatic NSCLC with PD-L1>1% and HER2-mutation?
No, I do not believe that this changes anything for that population. The immunotherapy trials excluded patients with EGFR and ALK, but did not necessarily exclude patients with HER–2 mutations. Given the impressive survival outcomes seen with immunotherapy and chemoimmunotherapy, personally, I would...
Would you offer adjuvant immunotherapy in a patient with high risk RCC with new/worsening post-op renal dysfunction and CrCl<30?
My preference in situations like this is to stabilize the renal function first. I am comfortable treating the patient with adjuvant pembrolizumab with a CrCl <30 mL/min but it should be stabilized first. That will make it easier to diagnose potential irAEs as compared to starting adjuvant treatment ...
What would be your next step in management for a patient with oligometastatic colon NEC who only achieved stable disease after 4 cycles of carboplatin/etoposide?
There are essentially 2 options here: 1) To take a therapy break; 2) To continue.Resection is only considered for highly selected cases of NEC and almost never for metastatic disease as early recurrence is the rule. I am not the only one who has noticed that the ORR and likely OS to platinum/etoposi...
Should radiotherapy be utilized in stage IVA NSCLC with a malignant pericardial effusion?
This has come up on occasions. I'm not aware of any high-quality evidence to guide one way or another. I would say, there may be a role for thoracic RT on a case by case basis. Though, I would preface all of this by stating that malignant pericardial effusion usually confers a poor prognosis.I assum...
Would history of breast cancer deter you from using ospemifene for severe vaginal dryness/dyspareunia?
The agonistic/antagonistic activity of ospemifene in different tissues that express estrogen receptors is incompletely understood and therefore, I would have reservations about using this agent in women with hormone receptor positive breast cancer. In fact, looking at the labeling information of osp...