Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
After prior BTKi + venetoclax and subsequent progression, how do you then choose next line therapy for high risk CLL?
In a patient having clinical progression after a fixed-duration BTKi + venetoclax, I first rule out Richter transformation and check for the acquisition of TP53 aberration and/or resistance mutations. Although the latter is rare in fixed-duration targeted therapies, it is important to rule it out. T...
After prior BTKi + venetoclax and subsequent progression, how do you then choose next line therapy for high risk CLL?
In a patient having clinical progression after a fixed-duration BTKi + venetoclax, I first rule out Richter transformation and check for the acquisition of TP53 aberration and/or resistance mutations. Although the latter is rare in fixed-duration targeted therapies, it is important to rule it out. T...
Does the lack of long-term data influence your consideration of utilizing zanubrutinib and venetoclax 1L in High-Risk CLL?
Not really. The CLL17 data showed essentially equivalent 3yr PFS between ibrutinib + venetoclax, ibrutinib monotherapy, and venetoclax + obinutuzumab. But even before those data were published, with the solid 36-month PFS data for zanubrutinib + venetoclax, it seemed clear that many of these patient...
Does the lack of long-term data influence your consideration of utilizing zanubrutinib and venetoclax 1L in High-Risk CLL?
Not really. The CLL17 data showed essentially equivalent 3yr PFS between ibrutinib + venetoclax, ibrutinib monotherapy, and venetoclax + obinutuzumab. But even before those data were published, with the solid 36-month PFS data for zanubrutinib + venetoclax, it seemed clear that many of these patient...
Do you check IGHV mutation status in patients with newly diagnosed CLL?
Yes. In the targeted therapy era, there are three factors that continue to have prognostic and therapeutic significance and should be checked: IgHV mutation status p53 aberrancy - requires both FISH for del17p AND mutation analysis for p53 Complex karyotype - can be done on peripheral blood or marr...
Do you check IGHV mutation status in patients with newly diagnosed CLL?
Yes. In the targeted therapy era, there are three factors that continue to have prognostic and therapeutic significance and should be checked: IgHV mutation status p53 aberrancy - requires both FISH for del17p AND mutation analysis for p53 Complex karyotype - can be done on peripheral blood or marr...
In a patient who has been receiving 1L Ibrutinib for TP53+ CLL for years with complete hematologic response but detectable MRD, is there any role to switch to the novel BTKi agents given better PFS?
There are a couple of features to this question that need comment. First, the goal of therapy with a single-agent BTKi, regardless of ibrutinib, acalabrutinib, zanubrutinib, or pirtobrutinib, is NOT to achieve undetectable MRD. Very few patients will achieve this milestone due to the drug's MOA. BTK...
In a patient who has been receiving 1L Ibrutinib for TP53+ CLL for years with complete hematologic response but detectable MRD, is there any role to switch to the novel BTKi agents given better PFS?
There are a couple of features to this question that need comment. First, the goal of therapy with a single-agent BTKi, regardless of ibrutinib, acalabrutinib, zanubrutinib, or pirtobrutinib, is NOT to achieve undetectable MRD. Very few patients will achieve this milestone due to the drug's MOA. BTK...
What is your protocol for type of surveillance imaging (CT/MRI/PET) and frequency of follow-up after SBRT to a bone metastasis?
I typically have approached decisions regarding surveillance based on the site (i.e., spinal vs. non-spinal bone metastasis), indication for SBRT (i.e., definitive or post-operative, particularly in spinal metastasis patients who required initial debulking), and primary site (i.e., radiosensitive, s...
How are you interpreting the early RASolute 302 trial findings (daraxonrasib) in metastatic PDAC?
This is an extremely exciting time in pancreatic cancer treatment! I note that PDAC/KRAS has a plenary this year at ASCO's Annual Meeting. The company has also put out a press release stating this is a positive study against chemotherapy with a doubling of overall survival. Of course, we all want to...