Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Is your standard of care for newly diagnosed advanced classical Hodgkin now nivolumab-AVD based on SWOG 1826?
I think the new standard of care for newly diagnosed patients with advanced classical Hodgkins Lymphoma is now nivolumab-AVD based on the early data from SWOG 1826. While we often wait for more mature data, the early improvement in PFS and the more favorable toxicity profile of this regimen over BvA...
Is your standard of care for newly diagnosed advanced classical Hodgkin now nivolumab-AVD based on SWOG 1826?
I think the new standard of care for newly diagnosed patients with advanced classical Hodgkins Lymphoma is now nivolumab-AVD based on the early data from SWOG 1826. While we often wait for more mature data, the early improvement in PFS and the more favorable toxicity profile of this regimen over BvA...
What would you offer as adjuvant therapy for a resected stage IIIB adeno NSCLC in a patient who refuses chemotherapy?
Patients with stage III NSCLC are at very high risk for recurrence, and in this situation, I would make sure that your discussions with the patient highlight this clearly. My usual thought is that if a patient can tolerate and recover from lobectomy/resection, then that is a reasonable indication th...
Do you offer fertility preservation to patients prior to CAR-T therapy?
There is no evidence yet about the impact of CAR-T itself on fertility, and this will be difficult to study in isolation in this population. Many CAR-T patients have been heavily pre-treated, so semen cryopreservation and oocyte harvesting may not be successful; but if feasible they should be attemp...
Is there an absolute PSA level above which you would not recommend a radical prostatectomy for newly diagnosed prostate cancer despite the absence of metastatic disease with advanced imaging?
There is no absolute PSA level that would preclude radical prostatectomy in the absence of metastasis on staging imaging. However, I would explain to the patient that the chance of occult metastatic disease and the need for additional treatment after prostatectomy increases as the PSA increases. I w...
How long after lumpectomy for DCIS in a premenopausal patient can tamoxifen be started and still retain the benefit?
The TAM-02 trial showed that women with IDC who delayed taking tamoxifen 2 or more years after their diagnosis still did better than those who did not initiate it at all. You can extrapolate this data to ER+ DCIS as the protective benefit of estrogen blockade on breast tissue occurs whenever it is s...
Should we consider radiation therapy for patients with N2 EGFRm NSCLC who will receive osimertinib, though RT was excluded on ADAURA?
For an EGFR-mutant N2 disease, we favor adjuvant chemotherapy (OS benefit) and/or adjuvant TKI based on ADAURA trial (DFS survival). The only prospective data regarding the use of adjuvant radiotherapy comes from a phase III trial, Lung Adjuvant Radiotherapy Trial (Lung-ART), where patients were ran...
In patients with newly diagnosed HER2+ early breast cancer, what do you anticipate will become the standard sequencing for T-DXd, neoadjuvant (DB11) or adjuvant (DB05) treatment?
Trastuzumab deruxtecan (T-DXd) is currently recommended in the adjuvant setting for patients with residual invasive disease after neoadjuvant therapy, based on the DESTINY-Breast05 trial, while its use in the neoadjuvant setting remains investigational. Ongoing neoadjuvant trials are evaluating T-DX...
Have treatment recommendations changed for Stage I endometrial Cancer based upon PORTEC 4 results?
PORTEC-4a will almost certainly change recommendations for adjuvant treatment in high-intermediate risk stage I patients with endometrial cancer, and in at least 2 different ways, in my opinion. By following the molecular profiling guidelines, nearly half of these patients will avoid adjuvant treatm...
Would you recommend initiating a SGLT2i for proteinuria secondary to bevacizumab in a patient who has a sub-optimal response to an ACEi or ARB?
Obviously, SGLT2i were not studied in this setting. If the patient otherwise meets the criteria for approved uses of SGLT2i then it is reasonable to consider. The prescriber should make a careful assessment of the risk and risk factors for infections and monitor the Cr closely. An initial increase i...