Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Is DESTINY Breast-09 data sufficient for T-DXd/P to replace THP as the first line standard of care for HER2-positive metastatic breast cancer?
With the impressive improvement in PFS to a 1L PFS to a remarkable 40.7 months, T-DXd + P is definitely an attractive option. However, I do not think this will be an approach I use for all patients. For ER+ patients, a THP induction strategy, followed by maintenance HP + AI and palbociclib, is also ...
How would you approach post-op radiation recommendations in patients who had neoadjuvant chemoimmunotherapy for HPV mediated OPSCC s/p TORS who have a complete pathologic response (pCR)?
Neoadjuvant immunotherapy for patients with TORS-eligible HPV-positive malignancies should not be done off study. KEYNOTE-689 did not include early-stage HPV+ oropharyngeal cancer patients, and as such, there is no prospective data to suggest a benefit to neoadjuvant immunotherapy in this patient po...
What is your preferred 1L treatment for newly diagnosed Del(17p)/TP53 mutation, high-risk CLL?
For patients with TN-CLL with TP53 aberration, the treatment options are usually based on patient factors. If a patient is a candidate for combination therapy, I prefer to treat them with uMRD-guided BTKi+BCL2i ± CD20 mAb. I only add a CD20 mAb to patients with no history of frequent infections and ...
What is your preferred 1L treatment for newly diagnosed Del(17p)/TP53 mutation, high-risk CLL?
For patients with TN-CLL with TP53 aberration, the treatment options are usually based on patient factors. If a patient is a candidate for combination therapy, I prefer to treat them with uMRD-guided BTKi+BCL2i ± CD20 mAb. I only add a CD20 mAb to patients with no history of frequent infections and ...
When would you offer nivolumab/relatlimab to a metastatic melanoma patient following progression on BRAF/MEK targeted therapy?
It depends on what previous therapies have been used. If this patient has already progressed on anti-PD1 monotherapy and BRAF/MEK inhibitor, then TIL therapy should be explored. I would use IPI-3 and NIVO-1 as a bridge in that scenario, after harvest (can start before harvest as well if a date is no...
How do you determine the optimal duration for 1L doublet treatment in newly diagnosed High-Risk CLL?
Among patients with high-risk CLL and indications for treatment per iwCLL criteria (Hallek et al., PMID 29540348), treatment regimens can be broadly categorized into fixed-duration, MRD-guided, and indefinite therapies. Fixed-duration doublet regimens include acalabrutinib with venetoclax per the AM...
How do you determine the optimal duration for 1L doublet treatment in newly diagnosed High-Risk CLL?
Among patients with high-risk CLL and indications for treatment per iwCLL criteria (Hallek et al., PMID 29540348), treatment regimens can be broadly categorized into fixed-duration, MRD-guided, and indefinite therapies. Fixed-duration doublet regimens include acalabrutinib with venetoclax per the AM...
Do you routinely check EGFR mutational status in all resected NSCLC regardless of histology?
In the ADAURA trial, non-adenocarcinoma histology comprised < 5% of cases, which reflects the well-known distribution of sensitizing EGFR mutations which is largely found in adenocarcinomas. However, for patients who are never smokers or have remote light history of smoking with different NSCLC hist...
Where do you anticipate positioning Mim8 (denecimig) alongside existing options within your hemophilia A prophylaxis approach, assuming regulatory approval (FRONTIER2)?
It is hard to say at this point, but I suspect it will be similar to emicizumab - i.e., it will be more frequently than the currently available rebalancing agents. What remains to be seen is if it will replace emicizumab by way of better perceived efficacy or only if someone is deemed to have "faile...
Where do you anticipate positioning Mim8 (denecimig) alongside existing options within your hemophilia A prophylaxis approach, assuming regulatory approval (FRONTIER2)?
It is hard to say at this point, but I suspect it will be similar to emicizumab - i.e., it will be more frequently than the currently available rebalancing agents. What remains to be seen is if it will replace emicizumab by way of better perceived efficacy or only if someone is deemed to have "faile...