Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Are you offering PARP inhibitor alone or both PARP inhibitor and bevacizumab maintenance for HRD+ ovarian cancer patients after upfront treatment?
If already giving bevacizumab for tumor-related reasons at initial presentation, would continue to maintain and add parp inhibitor, however, otherwise would use avastin later at recurrence, typically.
Is there any role for direct oral anticoagulants in the treatment of antiphospholipid syndrome?
Triple-negative APS is a confusing category as includes seronegative APS, APS with non-conforming aPL such as anti-phosphatidylserine-prothrombin amongst others, and the universe of patients with thrombotic events unrelated to antibody-mediated hypercoagulable state (eg Protein S, C or anti-thrombin...
What is your approach for treating transplant-ineligible patients with relapsed blastic plasmacytoid dendritic cell neoplasm (BPDCN) who have progressed on tagraxofusp?
First, I would have to wonder why the patient is not transplant-eligible. A lot of times we say this, but evaluation at the transplant center might find a patient is eligible for a nonablative approach. Second, I would strongly recommend the patient enter a clinical trial. The mustang biotech bpdcn ...
What is your starting dose of ponatinib for CML?
The standard starting dose for ponatinib is 45 mg. That being said, many clinicians lower the dose to 30 mg or 15 mg once a response is achieved in an effort to lower the rates of adverse events. The ongoing OPTIC study is evaluating if it is safe/effective to start at lower doses. An interim analys...
Do you have a preferred systemic therapy for unresectable epithelioid hemangioendothelioma?
Treat it like an angiosarcoma, albeit with a lower probability of response. Options include weekly Taxol or Gemzar/Taxotere or doxorubicin +/- Ifosfamide, depending on the gravity of the disease status.
Is it safe to treat checkpoint inhibitor-induced arthritis with methotrexate or biologics?
How the safety of methotrexate or biologics compares to long term steroid use to treated checkpoint-inhibitor inflammatory arthritis has not been determined. With that said, steroids can have deleterious effects on the tumor response in addition to all the other known side effects. Therefore, for pa...
Which of the androgen blocking agents have the best CNS penetration for someone with metastatic CRPC with brain metastases?
There is no direct prospective clinical evidence to really answer this question, unfortunately. My approach to patients with CNS metastases (including epidural disease) from prostate cancer is to provide metastasis-directed therapy such as surgery or stereotactic radiation depending on a range of fa...
Would you consider giving FLOT entirely in the neoadjuvant setting for resectable gastric cancer?
I do favor trying to give all the chemotherapy upfront, including FLOT. This builds upon compelling data from other GI cancers, like rectal cancer and pancreas adenocarcinoma, and the evidence that there has never been a trial (to my knowledge) that showed worse outcomes with total upfront chemo, vs...
How would you approach timing of adjuvant chemotherapy in a Stage 1 TNBC lost to follow up for >1 month since surgery?
Delayed initiation of adjuvant chemotherapy beyond 60-90 days has been linked to inferior outcomes in several studies (see for example Chavez-MacGregor et al., PMID 26659132). However, if this worse outcome is primarily due to time delays in chemotherapy or driven by other variables (e.g. ability to...
Are you treating patients with RET-fusion+ metastatic NSCLC with RET inhibitors as the first line of therapy regardless of PD-L1 expression?
Yes, I do treat with RET inhibitors regardless of PD-L1 status given the response rates on the order of 70-85% in treatment naive patients with selpercatinib and pralsetinib. If we look to the data of immunotherapy in other actionable oncogene driven subsets of lung cancer like EGFR mt NSCLC, the re...