Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
What is the optimal treatment strategy for patients with stage IV NSCLC who have an actionable molecular target identified after initiation of first-line systemic therapy?
I am assuming that immune checkpoint inhibitors were held while molecular results were pending based on evolving literature in the field (Calles et al., PMID 32421452). My personal recommendation is to complete 2-4 cycles of platinum doublet chemotherapy and obtain repeat imaging after completing th...
How do you approach treatment for a patient with hypoplastic MDS who is not eligible for transplant?
I believe it is reasonable to try immunosuppressive therapy particularly if the patient is positive for HLA-DR15. I would treat such a patient with triple immunosuppressive therapy with horse ATG, cyclosporine, and eltrombopag (de Latour et al., PMID 34986284) if they are HLA-DR15 positive. If they ...
Are there concerns in use or dosing of immunotherapy agents in extreme obesity?
I do not have a threshold for dosing based on BMI. Flat dosing is now typically used for single agent immunotherapeutic agents such as durvalumab. We still do not know the optimal dosing, schedule, or duration of therapy defining the use of immunotherapy in general. There are reports that obesity is...
When planning to give adjuvant nivolumab for esophageal cancer, would you be comfortable with nivolumab with q4 weekly dosing as opposed to q2 weekly dosing?
I generally start with Q2 week dosing - as per the BMS CheckMate 577 protocol - so that I can make sure that there is not any immediate toxicity. In the study, the dosing was Q2 weeks until 16 weeks and then it moved to Q4 weeks. If a patient is doing well, I have moved to Q4 week dosing at 8 weeks ...
Would you consider patritumab deruxtecan on clinical trial instead of chemotherapy for patients with EGFR+ lung cancer progressive on osimertinib?
Patritumab deruxtecan has shown promising activity in patients with sensitizing EGFR mutations who have had disease progression on osimertinib or other TKI. A phase 1 trial was recently published showing a response rate of 39% in patients who had progressed on prior TKI and a median progression-free...
Do you avoid using tafasitamab in germinal center subtype diffuse large B-cell lymphoma?
I don’t! I think the rationale behind the question is that tafasitamab has to be given with lenalidomide which has been shown to be more efficacious in non-GCB DLBCL. The rationale of combining lenalidomide with tafasitamab has more to do with expansion of NK cells to augment tafasitamab-mediated an...
Do you treat de novo metastatic hormone sensitive prostate cancer presenting with a paraneoplastic syndrome more aggressively?
For these patients, I will likely add a GnRH antagonist early on to drop testosterone quickly. Depending on performance status and other patient characteristics, we still go through the discussion of adding docetaxel, abiraterone, enzalutamide, and apalutamide (I generally add about 3-4 weeks after ...
How will you decide between neoadjuvant CheckMate 816 approach vs adjuvant IMpower010 approach in a fit patient with EGFR negative resectable Stage II-III NSCLC patient with PD-L1 high expression tumor?
In general, our multi-d group believes in neoadj approach to shrink the tumor and apply systemic therapy at the earliest time point. Most neoadj approaches also continue the I/O after surgery if there is a good response. It may be that patients with a complete path response or without ctDNA may not ...
Is it safe to give large fraction stereotactic irradiation for brain metastases concurrently with VEGF inhibitors?
Is there any benefit to transplant patients with Ph+ ALL who have achieved MRD-negativity?
First, some semantics: Asking if there is a "benefit to transplant" may imply there are randomized controlled trials addressing this question, but none to my knowledge have been performed. The last "donor-no donor" trials done in adults with ALL in first remission largely occurred in the pre-TKI era...