Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
When would you consider gemcitabine/cisplatin with Y90 for patients with unresectable intrahepatic cholangiocarcinoma ?
There is very limited data supporting the gemcitabine/cisplatin chemotherapy together with Y90 for treatment of unresectable intrahepatic cholangiocarcinoma (ICC). Existing studies of this combined approach (such as PMID: 31670746) report small single-group studies, and there are essentially no comp...
What are your top takeaways from ISTH 2025?
MAYARI trial - this trial was a single-arm trial for "non-severe" iTTP (excluding patients with significant cardiac or neurologic involvement) where PLEX was only used as a rescue therapy. Patients were started on caplacizumab and immunosuppression with steroids and rituximab. A large number of pa...
What are your top takeaways from ISTH 2025?
MAYARI trial - this trial was a single-arm trial for "non-severe" iTTP (excluding patients with significant cardiac or neurologic involvement) where PLEX was only used as a rescue therapy. Patients were started on caplacizumab and immunosuppression with steroids and rituximab. A large number of pa...
Is there a role for resection of the cutaneous primary in a patient on dual-agent immunotherapy for metastatic melanoma?
Yes. The location and size (width, length) should be noted. The patient should first be treated with dual ICI. If the patient with metastatic melanoma, who has the primary intact, undergoes successful dual ICI therapy and has a documented CR, near CR, or excellent PR, which is typically noted within...
In what circumstances would you consider use of IDH inhibitors in high-grade astrocytomas?
Please forgive me for the length and directness of my response, but I believe it is important to first go over the INDIGO trial and explain why, in my opinion, it was a highly questionable study, with multiple significant methodological flaws and dubious evidence of Vorasidenib's efficacy.INDIGO tri...
How can you manage a patient with bilateral PCNs who requires Pluvicto administration?
We've treated several of these folks. In general, we ask the patients to ensure they are emptying the bags frequently for the first three days to minimize the volume of urine next to the skin. There have been reports of radiation dermatitis from Foley/PCN bags that are left in the same spot against ...
Would you offer neoadjuvant chemotherapy prior to trimodality therapy in a fit patient who refuses surgery for muscle-invasive bladder cancer?
Unfortunately, this is a question without a clear answer at this time. Trimodality therapy, consisting of maximal TURBT, chemotherapy, and radiation, appears to have equivalent outcomes and has NCCN Category 1 recommendations for patients with MIBC. We do not routinely do neoadjuvant chemotherapy fo...
Is there a preferred ALK targeting agent for patients with ALK+ mNSCLC presenting with CNS metastases?
We do not have head-to-head comparisons and thus bearing the caveats of cross-trial comparisons given the heterogeneity in patients enrolled (e.g. baseline brain mets and type of treatment received), we do this exercise given the limitations of available data. There are considerable differences in b...
How do you think about sequencing therapy for a patient with ALK+ metastatic NSCLC given the available options?
The types and incidence of resistance mutations vary based on the 2nd generation ALK inhibitor given, and is most commonly the G1202R mutation, which unfortunately denotes resistance to alectinib where it accounts for about 29% of acquired resistance and brigatinib where it accounts for about 43% of...
What are your top takeaways in Gyn Cancers from ESMO 2025?
Studies presented at ESMO 2025 give a glimmer of hope to patients with platinum-resistant ovarian cancer, an area of gynecologic oncology where too little progress has been made. There were also numerous trials (too many to discuss here) presented involving ADCs, along with important updates to prev...