Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
What is your target Hgb/Hct for women who are pregnant and have sickle cell disease in whom you are doing scheduled transfusions?
Assuming that the patient is truly transfusion-dependent, the usual target range is a Hb of 9.5-10.5.
What is your target Hgb/Hct for women who are pregnant and have sickle cell disease in whom you are doing scheduled transfusions?
Assuming that the patient is truly transfusion-dependent, the usual target range is a Hb of 9.5-10.5.
How would you approach local therapy (surgery or RT) in a patient with radiographic complete response after chemoimmunotherapy for non-small-cell lung cancer?
Only 1/96 patients (0.6%) of patients on CheckMate 816 had a complete response by RECIST so I don't think our current paradigms are really driving these kinds of responses. Additionally, there is clearly a disconnect between clinical response rates by RECIST (0.6%) and pathologic complete response (...
In a patient with negative Hep B surface Ag, Hep B surface antibody+, and Hep B core antibody+ serologies, do you initiate antiviral prophylaxis (e.g. entecavir) prior to starting rituximab?
I would use entecavir for Hep B reactivation prophylaxis in this case - based on recommendations from AGA 2025 guidelines, which does classify b-cell depleting agents as higher risk for reactivation for both Hep B surface Ag-positive and Hep B surface Antigen neg/core positive patients. It should be...
Would you offer first line atezolizumab plus bevacizumab in unresectable/metastatic hepatocellular carcinoma based on the IMbrave 150 data?
I would definitely discuss (and offer) atezolizumab/bevacizumab as first-line therapy for advanced HCC and in fact, I have already started the treatment in 3 patients. There is no denying that this is the greatest advance in first-line therapy since the presentation/publication of the SHARP trial an...
Do the results of IMvigor011 influence you to utilize ctDNA to guide all adjuvant IO in MIBC?
Based on ESMO '25 data, I am using ctDNA in ICI-naive patients s/p radical cystectomy (with or without neoadjuvant chemotherapy) to inform the decision & timing of potential adjuvant nivolumab (FDA-approved) (following IMvigor011 design). I acknowledge the logistical burden of every-6-week ctDNA tes...
Would you use triplet chemotherapy FLOT in lieu of chemoRT for patients with localized esophageal squamous cell carcinoma?
This is a timely question in esophageal SCC (ESCC), even as we adjust to the now markedly diminished role of pre-operative chemoradiation vs. FLOT in esophageal/GEJ adenocarcinoma, based on the recent phase III ESOPEC study [Hoeppner et al., ASCO 2024; LBA1] (as well as the NeoAEGIS study that prece...
What is your approach to initial management of patients with suspected or confirmed primary cutaneous CD8+ positive aggressive epidermotropic T- cell lymphoma (PCAECTCL)?
PCAECTCL is an exceptionally rare and clinically aggressive subtype of cutaneous T-cell lymphoma, characterized by a rapidly progressive course, ulcerated or necrotic skin lesions, and early dissemination to extracutaneous sites. Due to its rarity and lack of standardized guidelines, management is l...
How do you approach adjuvant therapy for resected lung adenocarcinoma that was found unexpectedly postop to be N2?
Preliminary results of the phase 3 randomized LungART trial (NCT00410683) were recently presented at a virtual ESMO conference. 501 patients with pathologically confirmed N2 NSCLC s/p complete resection were randomized to postoperative RT (54 Gy) or observation. Almost all patients received chemothe...
In a newly diagnosed elderly patient with AML who harbors an IDH1 mutation, would you treat with upfront with ivosidenib/HMA or would you proceed with venetoclax and HMA as your first line treatment?
For me, the decision whether to treat this patient with IDH1 inhibitor monotherapy (ivosidenib) vs. venetoclax/HMA depends on how fit this patient is and his/her desire for aggressive therapy and inpatient vs ambulatory care. Prior data suggests very high response rates (90-100%) following venetocla...