Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
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...
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...
How do you decide among AI, full dose tamoxifen and low dose tamoxifen in a postmenopausal woman with DCIS without contraindications to either therapy?
My decision about AI vs tamoxifen is based on comparing the risk/benefit ratio for the specific patient. The cause of mortality in post-menopausal women is primarily cardiovascular disease, with osteoporosis also causing significant morbidity and mortality. Degenerative joint disease adversely affec...
How would you manage a solitary, painful, lytic bony lesion in a patient with negative PET/CT but bone marrow biopsy confirmation of multiple myeloma?
This is a palliative scenario, but the approach may differ based on the clinical circumstances. If Heme Onc is planning on administering systemic therapy, then a short course of palliative RT to expedite pain control would be appropriate. Treatment of many sites (e.g., femur) can be done very quickl...
How do you choose between liso-cel and axi-cel in patients with early relapse DLBCL for whom you are recommending CAR T-cell therapy?
Axi-cel and liso-cel are anti-CD19 chimeric antigen receptor (CAR) T-cell products approved for primary refractory or early relapsed (<1 year from initial chemoimmunotherapy) diffuse large B-cell lymphoma (DLBCL). Both products exhibit excellent efficacy (overall response rates >80%) and are potenti...
How do you choose between liso-cel and axi-cel in patients with early relapse DLBCL for whom you are recommending CAR T-cell therapy?
Axi-cel and liso-cel are anti-CD19 chimeric antigen receptor (CAR) T-cell products approved for primary refractory or early relapsed (<1 year from initial chemoimmunotherapy) diffuse large B-cell lymphoma (DLBCL). Both products exhibit excellent efficacy (overall response rates >80%) and are potenti...
How do you treat metastatic breast cancer which is HR positive, Her2 negative with PIK3CA+ and high tumor mutational burden (>10) who progressed after prior ET+CDK 4/6 and PIK3CA inhibitor therapy?
I will take an initial stab at this, but I know there are varying thoughts from other clinicians and I'm always interested to learn how others think through this.To start, I'm guessing that you're asking about immunotherapy here, and when you might consider using it. Unfortunately, these patients ha...
In light of the challenges with non-adherence to oral therapies in breast cancer, how do you monitor patient adherence in your practice?
There are several strategies here. Much of this is around patient education and the clinic team of nurses, physicians, APPs and oncology pharmacists can all support our patients by ensuring there is good understanding of the dosing schedule, potential side effects and how we might manage those, impo...
Do you typically recommend avoiding neupogen during radiation treatments?
It depends on the reason and expected benefit. If myelosuppression is holding up RT for cervical cancer patients, then I would not hesitate to give neupogen to avoid or minimize a treatment break. There would be more benefit to neupogen and continuing RT than a downside. Usually, I would try to give...