Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Do you recommend testing for UGT1A1 prior to initiating sacituzimab govitecan for patients with metastatic TNBC to mitigate neutropenia risk?
The phase I/II study of sacituzumab govitecan (SG) treated patients with various solid tumors and 146 patients had UGT1A1 testing. Let's first look at diarrhea. The overall incidence of grade 3 diarrhea was low (6.8%) and could not be predicted by any of the three haplotypes at the 10 mg/kg dose lev...
What is your approach to determining fitness for patients to undergo CAR-T therapy for relapsed/refractory multiple myeloma, and any absolute perceived contraindications for CAR-T?
This is a great question to which the only truly correct answer is, "It depends." Not just on the patient & disease biology, of course, but also the year in which the question is answered. For example, right now there are patients for whom commercial cilta-cel or ide-cel are not appropriate because ...
How would you approach choosing a regimen for a patient with multiple myeloma refractory to Daratumumab and Lenalidomide, with severe neuropathy from Bortezomib?
That's an excellent question with many answers. Ideally, CAR-T therapy is a strong option, particularly based on the findings from the CARTITUDE-4 trial. If the patient is uncertain about CAR-T, then carfilzomib-based therapy is a viable alternative. This option can be effectively combined with eith...
How would you approach choosing a regimen for a patient with multiple myeloma refractory to Daratumumab and Lenalidomide, with severe neuropathy from Bortezomib?
That's an excellent question with many answers. Ideally, CAR-T therapy is a strong option, particularly based on the findings from the CARTITUDE-4 trial. If the patient is uncertain about CAR-T, then carfilzomib-based therapy is a viable alternative. This option can be effectively combined with eith...
How do you approach the second-line treatment for a patient with high-risk myeloma relapse early post-autoHCT after Dara-RVD induction?
Depending on the nature of the relapse, I would salvage with DCEP, or carfilzomib-based triplet (KCyD, KPd) with ciltacel as the next step.
How do you approach the second-line treatment for a patient with high-risk myeloma relapse early post-autoHCT after Dara-RVD induction?
Depending on the nature of the relapse, I would salvage with DCEP, or carfilzomib-based triplet (KCyD, KPd) with ciltacel as the next step.
How would you manage a premenopausal female with cT2cN0 HR+/HER2-negative breast cancer who received neoadjuvant TC for high OncoType, had no pathologic response to therapy and upstaged to pT2N1 on surgery?
There is definitely a shift in administering more neoadjuvant therapy in ER+Her2- disease. However, I tend to avoid the use of TC in the neoadjuvant setting as the treating oncologist can be left with this conundrum. However, with the COVID pandemic and other reasons that may be needed to delay surg...
Would you consider a CDK 4/6 inhibitor in combination with endocrine therapy for a patient with ER low (1-9%) metastatic breast cancer?
Whereas ER 1-9% represents a heterogeneous group of tumors with relatively poor response to endocrine monotherapy, there are few if any data on whether this group of patients should be excluded from the use of CDK 4/6 inhibitors. For example, Finn et al. demonstrated that in the PALOMA-2 study, ER H...
Would you offer adjuvant abemaciclib + an aromatase inhibitor to a patient with a local HR+HER- breast cancer reoccurrence while on tamoxifen that meets high-risk criteria?
I would consider using abemaciclib and aromatase inhibitor therapy for a local recurrence while on adjuvant tamoxifen for someone who otherwise met the criteria for adjuvant therapy based on the FDA approval upon results of the monarchE trial (1). While not formally tested in this population, the on...
How do you view the use of adjuvant CDK4/6 inhibitors overall given discordant results between MonarchE and PALLAS?
Given the final results of PALLAS (SABCS 2021), there is no role for adjuvant palbociclib in high risk ER positive breast cancer at this time. No subgroup seemed to benefit. We await the extensive translational studies to get a better idea of what went on with the trial. 45% of patients discontinued...