Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How do you treat metastatic BRAF-mutated small bowel adenocarcinoma in the first-line setting?
This is the optimal approach based on the BREAKWATER data and known activity of FOLFOX. There will never be a specific study for this entity. Sometimes we must extrapolate.
Are there any concerns with live vaccine innoculation and patients who are on denosumab?
This is a complicated question because while denosumab is a biologic therapeutic that has immunomodulatory effects on innate and adaptive immunity its association with serious infections complications appears modest. An increased rate of background infections and some increase in serious infections ...
How would you manage a patient with polycythemia and MPN symptoms (aquagenic pruritus, fatigue) that is JAK2/CALR/MPL negative but peripheral blood NGS positive for IDH2?
I would approach this through the framing of a polycythemia/erythrocytosis workup and then consider MPN-related interventions if a diagnosis is made! This is an excellent review that provides an overview of erythrocytosis investigation (Noumani et al., PMID 38695361). In brief, I would be thinking a...
How would you manage a patient with polycythemia and MPN symptoms (aquagenic pruritus, fatigue) that is JAK2/CALR/MPL negative but peripheral blood NGS positive for IDH2?
I would approach this through the framing of a polycythemia/erythrocytosis workup and then consider MPN-related interventions if a diagnosis is made! This is an excellent review that provides an overview of erythrocytosis investigation (Noumani et al., PMID 38695361). In brief, I would be thinking a...
What is the preferred second-line therapy for HER2-positive patients with esophageal squamous cell carcinoma who have progressed on first line Trastuzumab and Immunotherapy?
HER2 overexpression in esophageal squamous cell carcinoma (ESCC) is relatively uncommon compared with gastric or gastroesophageal junction adenocarcinoma. Published estimates suggest that approximately 5–10% of ESCC cases are HER2-positive (Egebjerg et al., PMID 33865993; Rong et al., PMID 32209107;...
What is the preferred duration of adjuvant aromatase inhibitor therapy in patients with triple positive breast cancer?
The preferred duration in ER+PR+/-HER2+ disease for adjuvant aromatase inhibitors is not specifically defined in guidelines separate from ER+ disease in general. An older study looking at recurrence patterns across HER2+ disease (Park et al., PMID 19956951) showed ER+HER2+ disease had more delayed r...
What duration of ADT do you recommend for a patient with locally treated prostate cancer who undergoes metastasis-directed radiation therapy to a single oligometastatic bone lesion?
While I agree with @Dr. First Last that very small studies like STOMP and ORIOLE suggest that a small subset of men can delay the need for ADT by 1-3 years, this is not level 1 evidence. Most men with oligometastatic HSPC will still progress with metastasis directed therapy alone over a short time h...
Would you recommend adjuvant olaparib in a premenopausal BRCA1+ woman with stage IA pT1bN0 ER/PR+ HER2- breast cancer and a high OncoType score?
This is a data-free zone. Although this patient appears to have a high recurrence risk based on her Oncotype RS, she does not seem eligible for adjuvant olaparib based on her clinical-pathological characteristics. The Oncotype RS was not taken into consideration as part of the eligibility criteria i...
Are patients with MIBC and bladder neck involvement good candidates for bladder preservation with chemoradiation after maximal, but not complete, TURBT?
Both BCON and BC2001 suggest that a complete TURBT may not be essential for bladder preservation. Incomplete TURBT is a surrogate for a higher stage and predicts poorer outcomes irrespective of the modality used for treatment.Elumalai et al., PMID 36517194
How do you choose between blinatumomab and CAR-T cell therapy for relapsed or refractory pre B-ALL?
Many of the cellular therapy products are limited in indication which can help with making the decision, as well as the plan to go to transplant or not. Blinatumomab would have to be consolidated with HSCT while CAR-T can be curative in about 50% of patients without consolidative HSCT, which would b...