Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How will you weigh the positive PFS but negative OS benefit when discussing Dato-DXd with patients?
I think it will be increasingly difficult to prove OS in an environment where patients should have access to highly active ADCs at progression. Positive PFS is meaningful for our patients when associated with a well-tolerated regimen that has a favorable dosing schedule and quality of life metrics.
What supportive care measures do you prioritize to manage or prevent toxicity in patients receiving Dato-DXd?
My supportive care approach is centered around early identification and management of interstitial lung disease (ILD) and mucositis, both of which were observed in the TROPION-Breast01 trial. Twelve patients (3.3%) in the Dato-DXd arm had adjudicated drug-related ILD/pneumonitis. I routinely obtain ...
How does the safety profile of Dato-DXd influence its use in patients with comorbidities or frailty compared to standard chemotherapy?
There were fewer high-grade adverse events seen with Dato-DXd compared to investigator’s choice chemotherapy (20% vs. 45%, respectively), though we do see higher rates of nausea, stomatitis, fatigue, alopecia, and dry eyes or keratitis with Dato-DXd compared to chemotherapy. With the use of prophyla...
How will you sequence Dato-DXd among available therapies for HR positive, HER2-0 metastatic breast cancer?
While the approval of Dato-DXd for advanced HR+ HER2- breast cancer offers another TROP2 ADC with an improvement in clinical outcomes, there remain several unanswered questions and uncertainty about how to best utilize and sequence the ADCs for metastatic breast cancer. For patients with HR+ HER2 lo...
What factors should be considered when deciding between datopotamab deruxtecan and sacituzumab govitecan for a patient with metastatic breast cancer?
When choosing between Dato-DXd and SG, I consider payload differences, toxicity profiles, and prior therapies. Dato-DXd delivers DXd (an exatecan derivative), while SG delivers SN-38 (active irinotecan metabolite). SG demonstrated an OS benefit in TROPiCS-02 (JCO 2023), whereas Dato-DXd showed a PFS...
What scenarios, if any, are you delaying adjuvant chemotherapy in light of the COVID-19 outbreak?
This is a complex issue that our group here at MSKCC is dealing with right now, with formalized guidance pending. This is in mind of the fact that the mortality rate in Chinese patients with cancer approached 6%. While I wouldn't delay starting adjuvant therapy—which is being given with curative int...
Is it safe to use medroxyprogesterone for vasomotor flushing?
There are many options for management of hot flashes including venflaxine and gabapentin being most frequently used as well as some data on cognitive behavioral therapy, oxybutynin, and acupuncture. For the most refractory cases, I do discuss medoroxyprogesterone 400 mg IM as a one time option based...
How, if at all, does the spectrum of HER2 positivity impact efficacy of T-DXd in the frontline setting?
Multiple studies have shown that HER2 3+ disease is a predictor for exceptional (long-term) response to first-line THP, and conversely, patients with HER2 2+/FISH positive disease are less likely to experience an exceptional response to THP. While I have not seen a subset analysis by HER2 2+ vs 3+ p...
Should we be utilizing prophylactic G-CSF in our patients with intermediate risk of febrile neutropenia due to the COVID-19 pandemic?
There are many functions of G-CSF, including repression of T-cell and NK cell function. Unless you are certain that growth factors are not modifying the immune network to the detriment of viral clearance—there is no data that growth factors help clear viral infections.
Given results of the IDEA study presented at ASCO, would you consider truncating adjuvant therapy with stage II colon cancer?
The question asked is how one would consider incorporating the recent findings from the IDEA study into the utilization of adjuvant chemotherapy for patients with stage II colon cancer. The findings from this landmark study indicated that under certain circumstances, specifically those of patients w...