Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Would you offer live vaccines (e.g., MMRV/measles) to patients on bispecific antibodies for multiple myeloma?
I agree with the answer here by Dr. @Dr. First Last. There are a lot of nuances, though. In regard to giving the vaccine safely and effectively, the best strategy is not to wait until patients have multiple relapses and are on bispecific therapy to vaccinate. Given the recent outbreaks of measles, i...
Would you offer live vaccines (e.g., MMRV/measles) to patients on bispecific antibodies for multiple myeloma?
I agree with the answer here by Dr. @Dr. First Last. There are a lot of nuances, though. In regard to giving the vaccine safely and effectively, the best strategy is not to wait until patients have multiple relapses and are on bispecific therapy to vaccinate. Given the recent outbreaks of measles, i...
When would you continue atezolizumab/bevacizumab beyond progression in advanced HCC?
There are many effective drugs now in HCC. If there is true progression, I would change therapy. What is true progression? I think, a confirmed new lesion and/ or significant growth of the current disease. A few mm seen on a scan sometimes is read by radiology as PD but if the lesion is 8 mm, it's n...
How would you approach adjuvant therapy in a patient with HR+ breast cancer with a high RS (>25) given the current COVID-19 pandemic?
The starting point for consideration of adjuvant chemotherapy is to quantify the risk of a distant recurrence. For estrogen receptor positive, HER2 negative breast cancer, Oncotype Dx RS data are critical for understanding the risk of a distant recurrence1 as well as endocrine and chemotherapy respo...
How do you approach initial anticoagulant selection in hemodynamically stable hospitalized patients with newly diagnosed pulmonary embolism?
Low-molecular-weight heparin demonstrates the greatest benefit in patients with cancer-associated pulmonary embolism, intermediate-risk PE, and those requiring outpatient management. While LMWH shows superior efficacy and safety compared to unfractionated heparin across most patient populations, cer...
For transplant-ineligible aplastic anemia planned for immunosuppression, how do you approach duration and tapering of cyclosporine and eltrombopag?
One of the most common mistakes in the management of AA is premature tapering of cyclosporine or tacrolimus. If there is a complete remission, and by that I mean normalization of counts, not complete remission as defined in some papers (e.g., ANC 1000, Plts 100,000, Hb 10 as in de Latour et al., PMI...
How do you contextualize the stage 1 results from the PRESERVE-003 trial within the current treatment landscape for patients with squamous NSCLC who have progressed on PDL-1 therapy?
The PRESERVE-003 trial evaluated gotistobart, a novel CTLA-4 antibody, compared to docetaxel in participants with squamous cell NSCLC who had tumor progression on prior platinum-based doublet chemotherapy and immunotherapy. The trial was conducted in 2 stages, and results from the first stage are av...
What is your preferred assay for assessing dabigatran levels?
The only specific assay that would reflect drug levels is the ecarin clotting time with dabigatran as a calibrator. We used to have this assay in our lab, but due to a lack of use, it was discontinued. The standard thrombin time is too sensitive; however, dilute thrombin time has been used. The mass...
What are your top takeaways in Thoracic Cancers from ASCO 2025?
More presentations that were interesting for the future, than immediately impactful in thoracic oncology this year at the ASCO meeting. Immediately impactful: 8006 and 8008 – Both in SCLC. 8006- IMforte trial suggesting improvement in survival with the addition of maintenance lurbinectedin to atezo...
How do you approach Tarlatamab use in an elderly patient with relapsed ES SCLC?
Age is relative and there are numerous studies showing that well-performing elderly patients can tolerate systemic therapy to small cell lung cancer. That being said, I first assess whether additional cancer therapy is within the goals of care for each individual patient. While the outcomes for DLL3...