Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
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...
For patients with locally advanced GEJ adenocarcinoma with low PDL-1 score, will you still incorporate durvalumab with FLOT therapy?
Yes. I would still incorporate durvalumab with FLOT in patients with locally advanced GEJ adenocarcinoma even when PD-L1 expression is low. MATTERHORN was intentionally designed as an all-comers study without PD-L1 selection, and the event-free survival benefit was observed in the overall population...
For metastatic cholangiocarcinoma that has progressed on first line chemotherapy and immunotherapy, that is HER2 3+, which HER2 regimen is preferred, TDxD, Zanidatamab or tucatinib/trastuzumab?
With the studies specific to cholangiocarcinoma with these agents and risk profile, I’d favor the bispecific Zanidatamab over the antibody drug conjugate T-DXd.Smolenschi et al., PMID 40319675The pneumonitis/ILD is still a black box warning for the ADC and varies between 5-15% depending on which stu...
How should the use of the DecisionDx-Melanoma test be integrated into clinical practice to potentially avoid sentinel lymph node biopsy?
At this time, DecisionDx should be used as an extra piece of molecular information, not for clinical decision-making. The study done on DecisionDx was mainly retrospective, not prospective, so it has limited value in guiding patient care at this time. I would base your decision on SLBx on the curren...
Can post op RT be omitted in a surgically repaired pathological fracture site in multiple myeloma if the patient will receive systemic therapy?
For extremities (e.g., the femur), if the pain is largely from structural instability, which resolves after surgical stabilization, then proceeding with systemic therapy without post-op RT would be very reasonable. On the other hand, if the patient is having persistent pain after surgery from the os...
Can post op RT be omitted in a surgically repaired pathological fracture site in multiple myeloma if the patient will receive systemic therapy?
For extremities (e.g., the femur), if the pain is largely from structural instability, which resolves after surgical stabilization, then proceeding with systemic therapy without post-op RT would be very reasonable. On the other hand, if the patient is having persistent pain after surgery from the os...
What risk factors would favor the addition of ovarian function suppression to endocrine therapy in triple-positive breast cancer?
Young age less than 40, node positive, high-grade, bulky tumor, or any patient at high risk of recurrence (requiring chemo) or residual tumor, I would favor giving ovarian suppression as per the SOFT and TEXT trial.
What is your approach to pregnant patients with type 2B von Willebrand disease, particularly when thrombocytopenia is already present?
The gist of this challenging clinical problem is that the high estrogen levels in the third trimester of pregnancy raise the VWF level normally. In type 2B VWD, this effect raises the level of the abnormal VWF, which clears more platelets from the circulation, and can lead to severe thrombocytopenia...
What radiation doses and subsequent treatment monitoring would you recommend for multiple myeloma patients with multifocal bony lesions who decline chemotherapy?
Systemic therapy is the cornerstone of treatment for multiple myeloma, and the vast majority of patients initiate an appropriate regimen upon diagnosis. Occasionally, patients will have very limited disease and will be referred to Radiation Oncology for consideration of local therapy to delay the ne...
What radiation doses and subsequent treatment monitoring would you recommend for multiple myeloma patients with multifocal bony lesions who decline chemotherapy?
Systemic therapy is the cornerstone of treatment for multiple myeloma, and the vast majority of patients initiate an appropriate regimen upon diagnosis. Occasionally, patients will have very limited disease and will be referred to Radiation Oncology for consideration of local therapy to delay the ne...