Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Do you routinely stop ESA when starting myelofibrosis patients on JAK inhibitor therapy?
The management of myelofibrosis with anemia is becoming increasingly nuanced, given the several JAK inhibitors available to us and the potential for add-on therapies! An excellent resource to consider regarding decision-making is Jain et al., PMID 39808793. Regarding this specific question at hand, ...
Do you routinely stop ESA when starting myelofibrosis patients on JAK inhibitor therapy?
The management of myelofibrosis with anemia is becoming increasingly nuanced, given the several JAK inhibitors available to us and the potential for add-on therapies! An excellent resource to consider regarding decision-making is Jain et al., PMID 39808793. Regarding this specific question at hand, ...
How do you approach the outpatient management of bispecific antibody therapy for hematologic malignancies?
Multiple bispecific antibodies (BsAbs) targeting CD20 on lymphoma cells and CD3 on T-cells are now available in follicular and large B-cell lymphoma. A multi-disciplinary team with knowledge of the different BsAb indications and possible toxicities is an important aspect of safely administering thes...
How do you approach the outpatient management of bispecific antibody therapy for hematologic malignancies?
Multiple bispecific antibodies (BsAbs) targeting CD20 on lymphoma cells and CD3 on T-cells are now available in follicular and large B-cell lymphoma. A multi-disciplinary team with knowledge of the different BsAb indications and possible toxicities is an important aspect of safely administering thes...
What duration androgen deprivation do you recommend with salvage pelvic radiotherapy for pelvic node relapse after prostatectomy?
6 months ADT, 2 years ADT, 2 years ADT + abiraterone/prednisone seems reasonable depending on the circumstances. For example, early pelvic node recurrence for pT3b Gleason 4+5 would be a higher risk than a very late recurrence of pT2 Gleason 3+3.
In a patient with de novo metastatic RCC s/p Ipi/Nivo with partial response and residual viable RCC on cytoreductive nephrectomy, would you add cabozantinib or other TKI prior to disease progression?
No, committing a patient to the substantial (and frequently occurring) adverse events of anti-VEGF TKIs like cabozantinib would require convincing evidence of clinically meaningful benefit, which is currently lacking in this setting. I am supportive of well-designed trials to explore these questions...
What is your approach for perioperative chemotherapy in MSI-H/dMMR localized gastric cancer?
This question gets at aspects of MSI-H biology, biomarker testing and post-hoc data from the MAGIC and CLASSIC trials suggesting a lack of benefit, and potential negative impact of treatment in MSI-H patients. The following is restricted to gastric cancer, and the rates of MSI-H in true esophageal a...
How do you manage the side effects of ropeginterferon alfa 2b for polycythemia vera patients?
Great question. Although ropeginterferon is better tolerated than other interferons, it is still associated with adverse events. If counts are controlled, I would recommend lowering the dose or spacing out the dosing interval, as that usually helps. For flu-like symptoms, I recommend pre-emptive man...
What would your initial treatment be for an elderly patient with metastatic HER2+ GEJ cancer with PD-L1 <5 who cannot tolerate any platinum agents?
The current standard-of-care is based on the KEYNOTE-811 study, which established the combination of pembrolizumab with trastuzumab and a fluoropyrimidine/platinum doublet for tumors with a PD-L1 CPS of 1 or more. Very recently, trastuzumab has been replaced in the first-line setting by the results ...
How do you manage the side effects of ropeginterferon alfa 2b for polycythemia vera patients?
Great question. Although ropeginterferon is better tolerated than other interferons, it is still associated with adverse events. If counts are controlled, I would recommend lowering the dose or spacing out the dosing interval, as that usually helps. For flu-like symptoms, I recommend pre-emptive man...