Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
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?
We don't have specific data for this scenario, but there is no reason to think that SGLT2i would not have a beneficial role though I agree with Dr. @Dr. First Last that risk/benefit needs to be weighed. At the same time, in this particular scenario, I'd carefully look at the time course of proteinur...
What are the recommended second-line treatment options for patients with metastatic HER2+ breast cancer who have received frontline trastuzumab deruxtecan (T-DXd)?
There is currently limited direct evidence to guide optimal sequencing after frontline trastuzumab deruxtecan, so second-line treatment decisions are individualized. In many cases, the HER2CLIMB regimen with tucatinib, capecitabine, and trastuzumab is an appealing option, particularly for patients w...
In patients with advanced HR+, HER2- breast cancer who have progressed on first-line CDK 4/6i and ET and found to have ESR1 mutation, are you offering combination of abemaciclib and elacestrant in the 2nd line or SERD monotherapy?
In my practice, when treating patients with advanced hormone receptor-positive (HR+), HER2-negative breast cancer who have progressed on first-line CDK4/6 inhibitors and endocrine therapy, and who harbor ESR1 mutations, I typically consider elacestrant monotherapy as the preferred second-line treatm...
How do you select between imlunestrant ± abemaciclib and elacestrant for those with an ESR1 mutation and progressed on AI and CDK4/6 inhibitor for patients with metastatic ER+/HER2- breast cancer?
My choice of oral SERD to use in this setting would be based on side-effect profile and ease of administration, as both are approved for use after progression on 1st-line ET. Based on information from the phase III trials, EMERALD and EMBER-3, and in the absence of a head-to-head comparison, imlunes...
What is your approach to chronic non-immune mediated thrombocytopenia management in children?
There are whole textbook chapters on this topic, and we use a variant of this question to review the differential diagnosis of thrombocytopenia with our fellows as a didactic exercise. So I take from this question, which is an important one, what might be a framework to consider the differential dx ...
How would you approach a patient with metastatic HR+, HER2-negative, high-grade neuroendocrine carcinoma of the breast?
Carbo/VP16.
After the MAJESTEC-3 results, what is your approach to choosing between tec-dara vs. cilta-cel versus another triplet for multiple myeloma in first relapse?
This is an excellent question, and literally a million-dollar question for various companies involved. It's worth noting that the US FDA can change the package insert at will (and has done so) compared to what the trials did, so there's no guarantee as of yet that Tec-Dara (based on MajesTEC-3) will...
Would you implement CAR-T therapy earlier in practice if approved in earlier lines for multiple myeloma based on the KarMMa-3 and CARTITUTUDE-4 studies?
I agree with @Dr. First Last's excellent take on CARTITUDE-4 and KarMMA-3. For patients who have had 2 prior lines of therapy, I am absolutely going to reach for CAR-T (or bispecific antibodies as their earlier-line studies get published) with an emphasis on cilta-cel based on the data at hand.But w...
What is your preferred first-line therapy for transfusion-dependent beta-thalassemia?
Transfusions are the backbone of therapy for these individuals. Reducing transfusion burden is advantageous to minimize iron loading, space out transfusions, and improve quality of life. At present, there are 2 agents available - luspatercept and mitapivat. The clinical trial endpoints for both are ...