Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Do you continue daratumumab beyond 24 months in first line treatment of amyloidosis?
This is an important and common clinical question, and one for which prospective data are currently limited. For background, the ANDROMEDA clinical trial (Kastritis et al., PMID 34192431) demonstrated that the addition of daratumumab to cyclophosphamide, bortezomib, and dexamethasone (CyBorD) signif...
Do you continue daratumumab beyond 24 months in first line treatment of amyloidosis?
This is an important and common clinical question, and one for which prospective data are currently limited. For background, the ANDROMEDA clinical trial (Kastritis et al., PMID 34192431) demonstrated that the addition of daratumumab to cyclophosphamide, bortezomib, and dexamethasone (CyBorD) signif...
Would you add immunotherapy to FOLFOX if the patient is not a FLOT candidate for neoadjuvant gastric cancer, extrapolating data from the MATTERHORN study?
While it is always somewhat perilous to extrapolate from a proper study to lesser situations, this seems quite reasonable. It seems highly unlikely that the removal of Taxotere from a fluoropyrimidine-oxaliplatin-based regimen would render immunotherapy less effective in gastric cancer. In the MATTE...
How do you counsel eligible patients on lung cancer screening who are hesitant because of the cancer risk from CT scans?
This is simple. The risk of lung cancer in patients who have smoked for >20 years is orders of magnitude higher than the theoretical risk of medical X-ray-induced cancers from low-dose CT (LDCT) screening. A typical LDCT scan exposes patients to approximately 1.5 mSv of radiation, equivalent to abou...
Is there a role for induction chemotherapy for locally advanced head and neck squamous cell carcinoma prior to definitive chemoradiation?
Induction chemotherapy can be considered in some patients with locally advanced SCCHN, primarily those patients with large bulky tumors who are at highest risk for developing distant metastases. Moreover, if you are looking to attain reduction in tumor bulk for symptom control and possibly control o...
How would you manage a patient with DLBCL that progressed on/after EPOCH and subsequently treated with a CD19 allo CAR-T product within 90 days of receiving apheresis?
I'm sorry, but the question is unclear. Did his disease progress after CD19 allo CAR-T? If so, I would offer commercially FDA-approved CD19 CAR-T. The fact that his disease progressed quickly after allo CAR-T is possibly due to a lack of expansion and long-term persistence, which can be mitigated by...
In what scenarios do you use a chromogenic factor X assay in adjusting INR goals for patients on warfarin?
I do not use this method. It has been suggested that such assays be used in patients with lupus-type inhibitors who have significantly prolonged prothrombin times at baseline. In this setting, if the INR is "therapeutic," one would confirm an adequate warfarin effect if the factor X activity was in ...
In the current era of adjuvant CDK4/6 inhibitor use for high-risk HR+/HER2-negative breast cancer, what is the preferred adjuvant chemotherapy regimen for premenopausal women — AC-T or TC?
In premenopausal women with genuinely high-risk HR+/HER2- disease (MonarchE and some NATALEE groups, especially Stage III), I believe there remains a role for dose-dense AC/T as the adjuvant chemotherapy backbone. Data from EBCTCG do portray a 2.5–2.6% 10-year recurrence and 1.6% 10-year breast canc...
Do you offer consolidation durvalumab in a patient who had pneumonitis requiring steroids following chemoradiation for LS-SCLC?
In the ADRIATIC trial, pneumonitis or radiation pneumonitis occurred in 38.2% of durvalumab-treated patients, and 8.8% discontinued treatment due to pneumonitis (Cheng et al., PMID 39268857). While there is emerging interest in immune checkpoint inhibitor rechallenge after successful management of i...
Should a patient who requires definitive treatment for prostate cancer as a pre-transplant requirement be strictly required to complete their course prior to transplant/initiation of immunosuppression?
To help address this complex question, I would like to call your attention to a review of the topic by Al-Adra et al., PMID 32969590. It covers several types of malignancies, including prostate cancer (Table 4). Treating this patient will require close collaboration with the transplant surgeon, urol...