Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
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...
How would you treat a stage I fully resected double hit DLBCL?
In patients with fully resected DLBCL, I still give chemotherapy. That also applies to double-hit lymphomas. Limited stage DHL does not seem to have a poorer prognosis than non-DHL, and intensive regimens do not make a difference. I would treat with RCHOPx3-4 cycles.Torka et al., PMID 31945157Lue et...
How would you treat a stage I fully resected double hit DLBCL?
In patients with fully resected DLBCL, I still give chemotherapy. That also applies to double-hit lymphomas. Limited stage DHL does not seem to have a poorer prognosis than non-DHL, and intensive regimens do not make a difference. I would treat with RCHOPx3-4 cycles.Torka et al., PMID 31945157Lue et...
How do you approach systemic treatment for isolated CNS recurrence of ER+/HER2+ disease, with local treatment completed, with prior treatment with chemotherapy + anti-HER2 agents?
This is always a difficult scenario with no clear guidance, and I think depends on a good discussion with the patient. My preferred approach to this scenario is similar to an isolated CNS progression, in which we would not change systemic therapy if treated with local management. In this case, the p...
When treating rectal cancer with TNT and induction chemotherapy first, do you repeat pelvic MRI prior to planning for chemoradiation?
TNT approach options for pMMR T3, N any; T1–2, N1–2; T4, N any or locally unresectable or medically inoperable rectal cancer patients include:First chemotherapy for 12-16 weeks (FOLFOX or CAPEOX may also consider FOLFIRINOX) followed by long-course chemoradiation or short-course radiation, followed ...
How would you manage relapsed DLBCL in a patient who received second line CD19 CART treatment?
With commercial CD19 CAR-T therapy moving into earlier lines of therapy, post-CAR-T relapses are now more common. There are still many options depending on what first-line/bridging therapy was given, CD19/20/30 expression, and patient preferences. I always get a biopsy if feasible to confirm relapse...
How would you manage relapsed DLBCL in a patient who received second line CD19 CART treatment?
With commercial CD19 CAR-T therapy moving into earlier lines of therapy, post-CAR-T relapses are now more common. There are still many options depending on what first-line/bridging therapy was given, CD19/20/30 expression, and patient preferences. I always get a biopsy if feasible to confirm relapse...