Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Would you offer immunotherapy in addition to chemotherapy and trastuzumab for patients with metastatic HER2 positive gastroesophageal cancer with low PDL1?
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...
What approach is suggested for extended adjuvant endocrine therapy in a HR+ breast cancer?
This can be a complicated decision for which you need to take into consideration the patient's estimated risk of late recurrence, her understanding of that risk, how well (or poorly) she has tolerated the first 5 years of adjuvant endocrine therapy, and her age and comorbidities, including the prese...
What adjuvant therapy would you offer a postmenopausal woman with a new pT2N0 HR+/HER2+ breast cancer primary who is concurrently being treated with anastrozole/ribociclib for well controlled oligometastatic HR+/HER2- disease?
It is always disconcerting when a primary tumor arises in the context of already ongoing therapy. Presumably, this tumor is somewhat resistant. Firstly, I would add in anti-HER2 therapy (there is a broad range of options depending on the patient's details, ranging from single-agent trastuzumab to TH...
Are there patients in whom you would modify the course of adjuvant durvalumab in resected gastric/GEJ adenocarcinoma following treatment with neoadjuvant FLOT + durvalumab?
I would not de-escalate or modify the adjuvant course of treatment in the D-FLOT regimen based on the pathologic results. The protocol continues adjuvant durvalumab for 10 additional cycles after FLOT, but almost 50% of patients on the trial did not undergo these full 10 additional cycles, and so if...
In light of the recent results from STAMPEDE and LATITUDE, to which patients with newly diagnosed metastatic prostate cancer are you offering up-front abiraterone vs. up-front docetaxel?
Although I anticipate that the Stampede investigators will publish (an underpowered) comparison of their ADT plus docetaxel arm vs ADT plus abiraterone which may provide some insight, for the most part we will be in a data free zone re: this issue for some time. I suspect that clinicians will contin...
How would you approach a patient with a recent MI s/p DES who is being considered for neoadjuvant chemotherapy for TNBC?
This is mostly opinion as there is not data specific to this situation. First, I would coordinate closely with the cardiologist, preferably someone with knowledge of cardio-oncology. Presumably the patient is already on cardioprotective medications, such as beta blocker and ACE inhibitor, but if not...
How should Dato-DXd be managed in the absence of necessary resources for ocular exams and referrals?
We typically send patients for baseline slit-lamp exams prior to the start of Dato-DXd. If these resources are not available, telemedicine with slit-lamp biomicroscopic photography, as well as community screening resources, can be considered. Patients should still be educated on symptoms that would ...
When, if ever, do you incorporate a dental evaluation before initiating Dato-DXd to offer guidance on oral care and help limit oral toxicity?
A formal dental evaluation can be considered, but it is unclear whether it is necessary before starting Dato-DXd. Proactive dental evaluation, when feasible, should be used, but evaluation should not delay the start of treatment. The use of good daily oral hygiene, including salt/bicarbonate and Bio...
What clinical and pathological features are you using when selecting patients for adjuvant cemiplimab in high-risk CSCC, given the differences between trial inclusion criteria and NCCN guidelines?
Identifying the select patient population who benefits from adjuvant cemiplimab for cSCC is critical. Current staging systems for cSCC are inadequate to specifically identify the tumors at highest risk for relapse and disease-specific death. The majority of high tumor category and 'high risk' cSCC a...
What are best practices for dermatologists and oncologists to collaborate in order to optimize multidisciplinary care of patients with high risk CSCC?
A network of specialists familiar with cSCC is necessary to optimize care that is tailored and appropriate for each unique case. Avoiding under-treatment and over-treatment is important, but also challenging, given the high volume of cSCC tumors with variable patterns of presentation and numerous cr...