Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Would you offer anti-HER2 therapy to a patient found to have heterogenous HER2+ residual disease after original treatment for TNBC using the KEYNOTE-522 regimen?
This is complicated and there isn't a data driven right/wrong answer for this type of situation that I am aware of. Neoadjuvant treatment can cause shifts in biomarker results in residual tumor tissue compared to the pre-treatment specimen. KY-522 didn't do re-testing of residual tumor. I am not rou...
How does your approach to low-risk gestational trophoblastic neoplasia differ for patients whose hCG levels plateau following initial single agent systemic therapy vs those who have a good initial response and then plateau?
For patients with low risk GTN whose hCG values plateau over a two-week interval, concerns arise about chemoresistance. Unfortunately, there is no consensus or clear guideline in terms of determining chemoresistance and when to switch therapy. I don't approach the two clinical scenarios presented he...
What is your surveillance strategy in patients with brain metastases who are getting systemic therapy?
Generally, I’d consider a repeat MRI every 2-3 months, earlier if warranted. Assuming no evidence of disease progression for 1 or 2 years, I’d consider every 3-6 months.
Do you advocate for dose dense AC instead of every 3 week dosing in neoadjuvant TNBC as done in KEYNOTE 522?
When giving neoadjuvant therapy for TNBC as given in the KEYNOTE-522 study, I prefer to administer dose dense AC (with growth factor support) + pembrolizumab (after completing weekly paclitaxel and carboplatin + pembrolizumab). While there has been no comparison of dose dense vs. q3week AC with this...
How do you manage psoriatic arthritis in patients who are planning to start treatment with checkpoint inhibitors for underlying malignancy?
This is a very important question, and I think rheumatologists will encounter cases like this more frequently as immune checkpoint inhibitors (ICIs) are being increasingly used. Roughly, 50% of patients with co-existing autoimmune disorders and malignancies have flare-ups of their autoimmune disorde...
Would you recommend allogeneic stem cell transplantation for consolidation in a patient with follicular lymphoma who relapsed within 13 months of initial chemo-immunotherapy?
Updated answer - 9/18/23 The role for allogeneic stem cell transplantation in follicular lymphoma has become increasingly narrow as the therapeutic armamentarium has expanded. In the current state, even for early-relapsing patients, it would generally not be an early consideration; such patients are...
What is the benefit of cytoreduction with Hydroxyurea for patients with newly diagnosed chronic phase CML with a WBC count >100 prior to the initiation of a TKI?
For newly diagnosed patients with CML, there is no benefit to using hydroxyurea before TKI. Using HU oftentimes ends up causing cytopenias and it then makes it challenging to keep patients on their TKI when it is started. There are some scenarios where it is reasonable to use- if you don’t yet know ...
What are your top takeaways in Breast Cancer from ASCO 2022?
DESTINY-Breast04: it is phase III study of Trastuzumab deruxtecan (T-DXd) vs treatment of physician’s choice in HER2-low metastatic breast cancer (MBC). This study showed improved progression-free survival (PFS) and overall survival (OS) with T-DXd vs standard therapy in this patient population. T-...
What are your top takeaways in GI Cancers from ASCO 2022?
1. DYNAMIC study: I believe circulating tumor DNA (ctDNA) will dramatically improve personalized medicine for cancer patients. This study confirmed that ctDNA-based adjuvant chemo treatment significantly decreases the patients who need/are recommended for adjuvant treatment (50% reduction) without c...
What are your top takeaways in GU Cancers from ASCO 2022?
1. Bladder cancer. Potential new non-muscle invasive bladder cancer immunotherapy with N-803, an IL-15 superagonist plus BCG. Abstract 4508. Demonstrated striking complete and durable remissions (70%), bladder preservations over 1-2 years of follow up (>90% cystectomy free survival), favorable toxic...