Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How do you approach adjuvant therapy for resected lung adenocarcinoma that was found unexpectedly postop to be N2?
Preliminary results of the phase 3 randomized LungART trial (NCT00410683) were recently presented at a virtual ESMO conference. 501 patients with pathologically confirmed N2 NSCLC s/p complete resection were randomized to postoperative RT (54 Gy) or observation. Almost all patients received chemothe...
What are your top takeaways in Medical Oncology from SABCS 2025?
lidERA trial. This is the first phase III trial showing an advantage for an oral SERD giredestrant over standard endocrine adjuvant therapy in early breast cancer. Treatment with giredestrant led to a 30% reduction in the risk of invasive disease recurrence over standard endocrine therapy at the fir...
What are your top takeaways in Breast Cancer from ESMO 2025?
ASCENT-03: At ASCO, the results of ASCENT-04 already showed an improvement of PFS (11.2 months vs. 7.8 months) in first-line setting for PD-L1 positive advanced triple negative breast cancer patients treated with sacituzumab plus pembrolizumab compared to chemotherapy plus pembrolizumab. The ASCE...
Will you extrapolate EORTC 1333/PEACE-3 (enzalutamide + Rad223) to any other ARPIs for mCRPC?
PEACE-3 was a cooperative group study of radium-223 plus enzalutamide versus enzalutamide alone in men with mCRPC. There was a significant improvement in OS (38 months vs 32 months). Most patients in the trial were previously treated with ADT monotherapy instead of intensified therapy (i.e., ADT + A...
Do you recommend using a ctDNA assay for a patient with HER2+ metastatic breast cancer in a continued CR to guide decision about whether to stop HER2-directed therapy?
This is a good question and is not a rare situation in the management of HER2+ metastatic breast cancer. Radiographic complete response occurs with first-line treatment in 6-15% (CLEOPATRA, GIM-14, and other trials). Currently, the standard of care is to continue anti-Her2 therapy indefinitely. Howe...
How would you approach treatment for a HR+ HER2+ clinical T1c N0 male breast cancer?
If clinically node negative, he can receive surgery and then once confirmed to be pT1c pN0, you could provide the TH regimen (weekly paclitaxel x 12 cycles plus trastuzumab for one year). However, my favorite approach would be to give the same regimen in the neoadjuvant setting so that I can re-disc...
Do you regularly perform pharmacogenomic testing for patients prior to starting chemotherapy?
At my center, we routinely perform DPYD genotyping prior to chemotherapy with 5-FU or capecitabine. This is a practice that is supported by very strong evidence from multiple prospective studies (see especially Henricks et al., PMID 30348537). The most important benefit of screening for DPD deficien...
What is the longest acceptable interval between radical orchiectomy and adjuvant BEP for Stage IIB/III pure seminoma in the age of COVID-19?
Drs. @Dr. First Last and @Dr. First Last have worked with GCT experts to create practical recommendations during this pandemic. You can read these here. Briefly, these patients should be still be treated with timely curative intent. Treatment decisions will need to be individualized for each patient...
Would you recommend imatinib 400 mg BID or stay with the usual dose of 400 mg/day for adjuvant therapy for a patient with intermediate-high risk exon 9 mutated GIST?
This is an issue that has been debated for more than 10 years with no clear-cut evidence-based answer. A case can be made for both options. I personally start with 400 mg/d, watch the disease closely, and the first indication that the benefit is in question, increase the dose to 800 mg/d. Tolerance ...
When do you opt to administer IV iron for patients with heart failure who may also have anemia of chronic disease or at risk for iron deposition disease?
I do not hesitate to administer IV iron in a patient with heart failure (chronic inflammation) if serum ferritin levels are <30 ng/ml and TSAT is under 20%. This is the only way, besides blood transfusions, to improve Hgb levels in this patient population.