Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How do you sequence HER2-therapy in HER2+ biliary tract cancer with the positive results of tucatinib + trastuzumab and zanidatamab in phase 2 studies?
How do you approach post-transplant maintenance for patients with high-risk myeloma?
I'm migrating the discussion from another thread ("Top Takeaways from ASCO 2023") here, mainly because the premise of this question is based on new data about KPd maintenance in high-risk patients presented by Dr. Nooka and colleagues as an oral presentation this past ASCO 2023.@Dr. First Last's ins...
When, if ever, would you re-challenge with immunotherapy for patients with metastatic RCC?
Checkpoint inhibitors combinations (IO/IO and TKI/IO) are the most likely way for a patient to experience a durable response. However, we need better treatment options for patients who are experiencing disease progression to these therapies. A number of new immune treatments are currently in clinica...
Do you ever extend adjuvant imatinib for patients with high-risk, localized GIST beyond 3 years?
The NCCN guidelines appropriately recommend "at least 3 yrs" of adjuvant Imatinib in intermediate to high risk, resected GIST. The decision to continue longer becomes a personalized one based on risk of recurrence, tolerance to Imatinib, coverage, etc. There are scenarios where both, the provider an...
What are your top takeaways in GU Cancers from ASCO 2023?
THOR study. Improved overall survival (HR 0.64 p=0.005) and PFS (HR 0.58 p=0.0002) of the oral FGFR tyrosine kinase inhibitor erdafitinib in FGFR altered metastatic urothelial carcinoma over chemotherapy. Establishes a new standard of care in the second/third/fourth line setting after failure of ch...
Would you treat the prostate in a patient with widely metastatic disease who has CR to all metastatic sites after systemic therapy or ADT?
This is an interesting hypothesis, but requires further study before offering. The trials that define a benefit to prostate RT in the metastatic setting (HORRAD, STAMPEDE, and now PEACE-1) did not use response-adapted selection criteria. Therefore, we cannot say that radiation to the prostate in an ...
For a patient with a lung tumor that is radiographically consistent with early-stage NSCLC but pathology with characteristics overlapping with upper GI origin, what additional diagnostic procedures would you consider before treating?
In the absence of imaging findings in a patient with a risk profile consistent with early-stage NSCLC, I would probably just move forward with definitive management as NSCLC with either surgical resection or SBRT as appropriate. The only other thing I would consider is to make sure they are up to da...
Would you offer a bone marrow biopsy to the patient with normal CBC and low MDS-associated mutation burden found on NGS?
Generally speaking, we don't perform NGS sequencing for MDS-associated somatic mutations in individuals with normal blood counts. However, the issue does arise when cancer patients undergo blood-based sequencing for other reasons, for example. And, in the future, we may see more mutation testing in ...
How do you schedule IV/PO Dexamethasone if giving immunotherapy concurrently with chemotherapy in patients with NSCLC?
We follow the methods listed in the clinical trial publications. For instance, KEYNOTE-189 followed standard steroid pre-medications for pemetrexed, and KEYNOTE-407 did the same for paclitaxel. Since the monoclonal antibodies tend to have long half lives and steroid premeds are given for such a shor...
With the current cisplatin and carboplatin shortages, for HPV+ H&N patients with indications for concurrent chemoRT, which agent do you recommend next?
The question of 2nd line therapy is difficult due to the dearth of data. This leaves essentially 3 choices - immunotherapy, cetuximab, or other cytotoxic agents.Regarding immunotherapy, recent trials for concurrent IO have been mixed, tending to compare IO vs Cetux. The main take-home though, is the...