Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
What are the recommended prophylactic measures for managing or mitigating diarrhea when pertuzumab is combined with trastuzumab deruxtecan, given toxicity risk with each individually?
My understanding is that prophylactic anti-diarrheals were not required in the trial but left to institutional discretion. While the rate of diarrhea in DB-09 was 56%, most of these were Grade 1-2 (only 7% were Grade 3 or higher). As such, I am not starting antidiarrheals prophylactically, but I do ...
Would you consider adding adjuvant ribociclib for a patient who has already received 2 years of endocrine therapy and is eligible for ribociclib according to the NATALEE trial?
Since the NATALEE trial excluded patients who received more than 12 months of neoadjuvant or adjuvant endocrine therapy, I would probably not consider ribociclib for your patient, as she is too far out from initiation of endocrine therapy.
Are there any data regarding safety or efficacy of osimertinib and concurrent chemotherapy in patients with metastatic NSCLC harboring sensitizing EGFR mutation?
The OPAL study evaluated 1st-line osimertinib combined with platinum-pemetrexed in 67 patients with EGFR-mutated NSCLC in Japan (Saito et al., PMID 36966696). The combination yielded an objective response rate of 90.9% (95% confidence interval, 84.0-97.8), with a median PFS of 31.0 months (95% CI, 2...
For a patient with metastatic melanoma with small, asymptomatic brain mets what is your preferred systemic therapy?
In this scenario, I default to using a combination of ipilimumab plus nivolumab. We know from prior clinical trials that have looked at this combination of patients with asymptomatic brain metastases that immunotherapy seems to work similarly well intracranially as it does extracranially. This was e...
Do you use lenalidomide for patients with MDS with 5q- without other cytogenetic abnormalities but with one or more mutations on NGS?
For patients who meet the definition of del(5q) syndrome, I typically utilize lenalidomide regardless of the molecular features of the disease. The original publication (List et al., PMID 15703420), the phase III MDS-004 study (Fenaux et al., PMID 21753188), and the phase III SintraREV study (Díez-C...
Do you use lenalidomide for patients with MDS with 5q- without other cytogenetic abnormalities but with one or more mutations on NGS?
For patients who meet the definition of del(5q) syndrome, I typically utilize lenalidomide regardless of the molecular features of the disease. The original publication (List et al., PMID 15703420), the phase III MDS-004 study (Fenaux et al., PMID 21753188), and the phase III SintraREV study (Díez-C...
How will your management of head and neck cancers change with the COVID-19 pandemic?
Short answer: Most head and neck cancer radiation is as necessary as it gets. At this point, my management won't change very much. That may change as the pandemic evolves. Use all the appropriate precautions to stop the spread of COVID-19 and other viruses (we are using masks for every staff member,...
When will you prescribe 3 v. 6 months of FOLFOX or XELOX for the adjuvant treatment of colon cancer?
This set of studies will do more to reduce toxicity for patients than any other studies presented at ASCO this year. Based on these results, I plan on treating stage III patients as follows: 1. For T4 and/or N2 patients, I will continue to recommend FOLFOX or CAPOX for 6 months, and continue to adju...
What are the treatment options for a patient with unfavorable intermediate risk PCa who desires future child bearing?
The best option for such patients would be sperm banking prior to treatment, whether they undergo RT+ADT or surgery. See this prior post on this forum regarding the impact of RT on fertility. Given the expected internal scatter dose to the testes during a course of fractionated RT, it would not be s...
When do you consider certolizumab for pregnant women with antiphospholipid syndrome with positive lupus anticoagulant?
Certolizumab is a TNF-α antagonist with minimal or no transfer across the placenta. It was evaluated in the phase 2, open-label IMPACT (Improve Pregnancy in APS with Certolizumab Therapy) trial to prevent placenta-mediated adverse outcomes in pregnant patients with antiphospholipid antibody syndrome...