Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
What is your approach to liver transplantation candidacy in those with decompensated cirrhosis who have been treated for a solid-organ malignancy, such as oral SCC?
This is an important consideration as patients who receive a solid organ transplantation will be on significant immunosuppression, which can result in significant proliferation of an underlying malignancy and have worse treatment outcomes compared to non-immunosuppressed patients. Furthermore, patie...
What criteria is needed in relapsed/refractory B-cell ALL to choose CAR-T therapy over conventional stem cell transplant as destination therapy?
Currently, there are no standard criteria used to choose CAR-T over conventional stem cell transplant as destination therapy. However, there are many factors that often push us in one direction or the other. As we learn more about outcomes after CAR-T cell therapy, there are many factors we know are...
What criteria is needed in relapsed/refractory B-cell ALL to choose CAR-T therapy over conventional stem cell transplant as destination therapy?
Currently, there are no standard criteria used to choose CAR-T over conventional stem cell transplant as destination therapy. However, there are many factors that often push us in one direction or the other. As we learn more about outcomes after CAR-T cell therapy, there are many factors we know are...
In which situations are you comfortable with alternative dosing of ovarian suppression (e.g Lupron q3m) for premenopausal patients during adjuvant breast cancer treatment?
My first option, when feasible/practical is to use every 4-week formulation of GNRH analog ovarian suppression treatment for hormone receptor-positive breast cancer. When that frequency of treatment presents a hardship, I generally feel comfortable with using ovarian suppression using depot GNRH ana...
How do you decide which immunotherapy agent to utilize for 1st line in PD-L1 high (>50%) NSCLC?
Now with the approval of atezolizumab based on the positive Impower110 study (led by @Dr. First Last and @Dr. First Last), we have 2 frontline checkpoint inhibitors to choose from. Indeed the data appears very convincing for both, therefore on scientific grounds, I would not be able to choose one ve...
Is there any role for prophylactic DMARD therapy to prevent immune-related adverse events (irAEs) in patients receiving immune checkpoint inhibitors?
Excellent and timely question!There are no good studies-- but I truly believe this is where we are heading for cellular therapies and IO. I am unsure if it will be DMARDs, as lung cancer patients get premetrexed with IO and still develop irAEs-- it will more likely be bDMARDs.The reason, I believe, ...
What treatment would you consider for ES-SCLC that is refractory to first-line platinum plus immunotherapy?
Tarlatamab is my go-to in this setting. However, I think there are still good questions about who are the best patients to treat with tarlatamab. Chemorefractory patients are generally ideal for tarlatamab as was stated before, it is a different mechanism of action than chemotherapy and the response...
What would be your radiotherapy plan for an overall stage IIA, low-lying, MMRd rectal adenocarcinoma to try to avoid APR?
For an MMRd rectal cancer, I would use immunotherapy! Very promising data from MSKCC suggesting upwards of 100% clinical complete response with dostarlimab alone, without the need for RT!
Is there a role for stents for patients with a new diagnosis of metastatic upper rectal cancer with a near-obstructing primary?
I haven’t had much luck with stents - they hurt, they often migrate, and tumor growth or perforation is also a risk. My preferred approach is a diverting colostomy, then total neoadjuvant therapy, then resection with eventual ostomy takedown. (This assumes curative intent disease.) Of course, this d...
How would you sequence/prioritize therapy for a patient with newly diagnosed large but relatively asymptomatic, limited small cell lung carcinoma of the lung with newly diagnosed partially obstructing ascending colon cancer with multiple large liver metastases confirmed to be of colon origin?
When two synchronous malignancies demand immediate intervention, a patient-tailored approach with overlapping regimens may be considered (Choudhary et al., ASCO 2025); however, in this particular case, sequential treatment is more appropriate given the asymptomatic nature of the colon cancer. There ...