Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Can ctDNA be used to evaluate response to checkpoint inhibitors in NSCLC when pseudoprogression is suspected on CT imaging?
This is a scenario where ctDNA may have value in the future, as imaging alone is often not sufficient to reliably differentiate between pseudo-progression and true progression in patients receiving immune checkpoint inhibitors. A small study of 28 patients with melanoma suggested that ctDNA obtained...
What is your approach for endocrine therapy in young women (<35 years old) with HR+/HER2+ breast CA with residual disease after TCHP who will start adjuvant T-DM1?
She would be given the options of tamoxifen or ovarian suppression with an AI for five years and then a discussion at that time based on where the data goes in that time. Tamoxifen would have fewer side effects but less effective reduction of PFS per extrapolation from the SOFT/TEXT trials. Ovarian ...
Are there any alternative, hypofractionated RT courses for patients with DLBCL that can be used during the COVID-19 pandemic?
ILROG recently came out with guidelines pasted below: Synopsis of ILROG Recommendations for Administering Radiotherapy for Hematological Malignancies During Emergency Conditions of the COVID-19 Pandemic • We are facing an increased demand for RT to substitute or complement systemic therapy deemed i...
How does the potential for a patient to accept or forego adjuvant tamoxifen factor into your recommendations on adjuvant RT for DCIS?
In the RTOG 9804 trial, the only factors predicting for local control in the breast were the use of radiation and of tamoxifen. So for women who have hormone positive tumors, I strongly advocate for some treatment in addition to the lumpectomy.I find the results of the UK, Australia, and New Zealand...
What is your response to the question, "Is this terminal?"
Thanks for this question, it's really important. This question comes up in two distinct scenarios: when a person is first diagnosed and when a person is nearing the end of her life. Let's talk about them in sequence. 1). At diagnosis: When a person is first diagnosed, this question is part of "getti...
When do you suggest ovarian suppression for fertility preservation in premenopausal women receiving neo/adjuvant chemotherapy?
The benefit of ovarian suppression in young breast cancer patients should be looked into from two different aspects. First, the suppression of the ovary resulting in the hormone receptor-dependent cancer stem cell (minimal residual disease) suppression, and second, the preservation of the fertility ...
Would you consider stopping nivo/ipi combination after a CR in a patient with metastatic melanoma?
Indirect data indeed suggest we can extrapolate the data on durable complete response after discontinuation of pemrolizumab. Indeed, most patients in complete response who stopped ipi/nivo combination for toxicity or any other reason in Checkmate 067 and 069 had durable ongoing complete response. Af...
Which patients would you treat with relugolix instead of injectable GnRH agonist therapy?
I would consider relugolix for patients with: 1. Intermediate-risk prostate cancer that needs a short course of androgen deprivation therapy 2. Patients with biochemical relapse that would benefit from a short course of ADT and salvage RT2.5 Patient with pre-existing cardiac comorbidities 3. Potenti...
Would you use upfront atezo/bev in a patient with HCC and untreated hepatitis?
Yes. I would not have concerns. For HBV, I would start treatment before or simultaneously. Studies have varied by protocol about the HBV viral load being under 500 or 100 but it is not clear this matters. There have not been flairs reported. In regards to HCV, again, not an issue for me.
What is your approach to mitigating the infection risk with bispecific antibodies in multiple myeloma?
I agree with Dr. @Dr. First Last. PCP prophylaxis may need to be considered.