Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
What systemic therapy, if any, would you recommend for a patient with oligometastatic melanoma who is rendered NED after resection?
This remains a very timely question and currently the data would allow for two options : observation vs adjuvant therapy with nivolumab.Observation is a very reasonable option since we know that this can result in prolonged overall and occasionally relapse-free survival in a subset of patients; howe...
Would you give adjuvant nivolumab for IIIA melanoma?
This is a very timely and excellent question. There have been recently three landmark adjuvant studies, and two recent FDA approvals that have changed our approach for patients with resected melanoma. All three studies were based on AJCC staging 7th edition and required patients to undergo complete ...
Do you consider tertiary grade pattern, LVI or PNI on prostatectomy specimens as adverse features to recommend EBRT and ADT for patients with unfavorable intermediate prostate CA after prostatectomy with undetectable PSA?
No, I don’t think there is any current available evidence to define a benefit for ADT in the post-operative setting for patients with an undetectable PSA. The two major trials which define a benefit for ADT in this setting, RTOG 9601 and GETUG AFU-16 had a lower limit of a PSA of 0.2 at treatment in...
How do you approach patients with stage III melanoma for adjuvant treatment?
Currently, there are FDA-approved adjuvant systemic therapy for stage III melanoma. These were based on the CheckMate 238 study (adjuvant nivolumab), KEYNOTE-054 (adjuvant pembrolizumab), and COMBI-AD study (adjuvant dabrafenib/trametinib). The KEYNOTE-054 compared adjuvant pembro vs placebo, with H...
What is your preferred first-line treatment for metastatic gastric adenocarcinoma that is PD-L1 CPS ≥ 10 and also HER2+?
Very recently, trastuzumab has been replaced in the first-line setting by the results of the HERIZON-GEA-01 study, which evaluated zanidatamab, a bispecific/biparatopic antibody against 2 epitopes of HER2. This study randomized patients to the control arm of trastuzumab/chemotherapy (Arm A) versus z...
Would you give chemotherapy and trastuzumab to a patient with multifocal high grade, microscopic (<5 mm) HR-, HER2+ IDC embedded in extensive DCIS, staged as pTis pT1a(m) N0?
The data is limited, especially in extensive high grade DCIS with microinvasion that is HER2 positive and the decision must build on the balance of benefit vs risk of treatment.In extensive DCIS with multifocal T1a as described in this question, I don't hesitate to recommend adjuvant chemotherapy wi...
Is there any role for elacestrant in patient who have received prior fulvestrant if they have ESR1 mutation?
The short answer is Yes!! The pivotal EMERALD trial that led to the approval of Elacestrant (oral Selective Estrogen Receptor Degrader) did enroll patients who previously received Fulvestrant (Faslodex). In a pre-planned subgroup analysis of EMERALD data, benefit of Elacestrant was seen even in subg...
What supportive care measures do you prioritize to manage or prevent toxicity in patients receiving Dato-DXd?
My supportive care approach is centered around early identification and management of interstitial lung disease (ILD) and mucositis, both of which were observed in the TROPION-Breast01 trial. Twelve patients (3.3%) in the Dato-DXd arm had adjudicated drug-related ILD/pneumonitis. I routinely obtain ...
Can AMPLIFY data be extrapolated to use of other BTKi's in combination with venetoclax or would you only ever use acalabrutinib/venetoclax in first line?
Indirect comparisons, including network meta-analyses and matching-adjusted indirect comparisons, suggest that zanubrutinib monotherapy may offer superior progression-free survival compared to fixed-duration acalabrutinib–venetoclax in low-risk, treatment-naïve CLL. However, these analyses rely on a...
Can AMPLIFY data be extrapolated to use of other BTKi's in combination with venetoclax or would you only ever use acalabrutinib/venetoclax in first line?
Indirect comparisons, including network meta-analyses and matching-adjusted indirect comparisons, suggest that zanubrutinib monotherapy may offer superior progression-free survival compared to fixed-duration acalabrutinib–venetoclax in low-risk, treatment-naïve CLL. However, these analyses rely on a...