Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
What are your top takeaways in Hematologic Malignancies from ASCO 2022?
Each year the American Society of Oncology Annual Meeting offers new or updated information that has the potential to change how we care for our patients. Here I highlight three hematology studies that are highly impactful, and which were rightfully highlighted at ASCO 2022. They serve to reinforce ...
Do you recommend maintenance immunotherapy after CR on chemotherapy for patients with metastatic TNBC?
The phase 2, KEYNOTE-158 study done in patients with metastatic solid tumors who progressed on at least 1 line of treatment, showed that 29% of 102 patients with TMB high status had an objective response compared to only 6% of 688 patients who had TMB low status, leading to FDA approval for tumor ag...
In patients with CML on imatinib and newly diagnosed breast cancer now requiring radiation therapy, should we hold imatinib?
There's not a lot of data regarding the best course of action in these rare situations. Anecdotally, I've had one CML patient who had been on dasatinib and was diagnosed with breast cancer a year or two after her CML diagnosis. Her local oncologist did hold her TKI while she was receiving radiation ...
Are there patients you currently utilize neoadjuvant TKIs for stage II-III NSCLC?
Absolutely not outside the context of a clinical trial. There are no data whatsoever on improved outcomes with this approach, and in fact, some older data with 1st gen EGFR TKIs show worse outcomes. In addition, I have tried it in a few patients and everyone relapsed rapidly with widely metastatic d...
In what scenario would you consider dual IO and TKI therapy in advanced stage melanoma?
Triplet therapy with the combination of vemurafenib, cobimetinib, and atezolizumab provides a new treatment option for patients with advanced BRAF-mutated melanoma. However, given the lack of survival benefit thus far and increased toxicity, I currently do not routinely employ this as frontline ther...
How would you treat a patient with blastoid mantle cell lymphoma with hepatic involvement causing significantly elevated bilirubin?
Tough situation. Ideally, if the cause of the liver dysfunction is the disease then based on age. The goal would be to start therapy in order to alleviate some of the disease burden to reduce the bilirubin level; if this isn't amendable, stenting or percutaneous drainage. If bilirubin can be improve...
In metastatic/recurrent clear cell carcinoma with a solitary site of metastasis to the bone when, if ever, do you consider local therapy adequate and hold systemic therapy?
If I have a patient with a treated solitary metastatic site in RCC (bone or otherwise), I generally give local therapy and historically would not give systemic therapy. A point of discussion would be use of adjuvant pembro in this setting. While bone mets were not included in KEYNOTE-564 resected M1...
What protocols or safeguards do you implement if bed bugs are found on a patient or their belongings while on the treatment table or near equipment?
Typically once a bedbug is identified, the patient is brought directly into our inpatient holding bay so that there is limited time to contaminate common areas of the department. Therapists do utilize contact precautions including knee high shoe covers. We then have our hospital facilities team trea...
Would you treat a patient with metastatic castration resistant prostate cancer and prior treatment with Ra-223 with Lu-117-PSMA-617 therapy?
Yes, assuming they are otherwise eligible with PSMA + disease, acceptable blood counts, etc. In fact, in cases with patients with bone only disease, many argue to start with Ra223 rather than Lu117 as if they progress beyond bone only disease and are treated with Lu117, they will not be able to rece...
Are there situations where you would start treatment for cardiac amyloid in a patient with amyloid seen on biopsy, but still pending mass spectrometry results?
I do not think of treating cardiac amyloid without the results of mass spec. You really need to know what type of amyloid you are dealing with.