Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
In a patient with BRCA2 mutation and contralateral axillary recurrence of ER+ IDC with an ESR1 CCDC170 fusion on NGS testing, would you use standard adjuvant AI therapy or consider adjuvant SERD therapy (fulvestrant/elacestrant)?
A lot of information is missing, like menopausal state, initial dx, previous chemo or no chemo, previous hormone status, adjuvant hormone therapy, type of hormone therapy if yes, and time of recurrence. All these are required for decision-making.
How do you decide between adjuvant trastuzumab vs trastuzumab/pertuzumab in a patient with localized HER2+ breast cancer post neoadjuvant TCHP who has achieved a pCR?
After the TRYPHAENA trial, TCHP became the standard of care neoadjuvant regimen for patients with Her-2+ localized breast cancer that was either LN+ or >2 cm in size primary tumor. This was based on a superior pCR rate of 67% compared to other regimens on this study. The standard of care at this tim...
How would you manage recurrent migratory lower extremity thrombophlebitis that occurs despite being on therapeutic apixaban?
The differential diagnosis of Trousseau syndrome (migratory superficial thrombophlebitis) is relatively broad and includes both inflammatory states and undetected proximal DVTs. So I think the short answer about venogram is "maybe," based on how clear is the view by ultrasound. This isn't a typical ...
Now that ropeginterferon is approved for PV, how do you select patients for this therapy?
First, I have no conflicts of interest with respect to ropeginterferon (rPegIFN). rPegIFN is a long-acting version (once every two weeks administration) of pegylated interferon (PegIFN) as opposed to once per week, which has been used for decades for the treatment of CML and MPN patients, without ra...
Now that ropeginterferon is approved for PV, how do you select patients for this therapy?
First, I have no conflicts of interest with respect to ropeginterferon (rPegIFN). rPegIFN is a long-acting version (once every two weeks administration) of pegylated interferon (PegIFN) as opposed to once per week, which has been used for decades for the treatment of CML and MPN patients, without ra...
Would you utilize OncotypeDX to guide decision making for a male with ER+ HER2- breast cancer and 1-3 positive sentinel lymph nodes?
I would be wary of using Oncotype Dx to guide treatment decisions for males with 1-3 positive lymph nodes. If we learnt anything from the prospective RxPONDER data, it’s that the biology of tumors varies in different cohorts of HR+/HER2- breast cancer patients. The Recurrence Score (RS) algorithm wa...
How would you treat an MMR-proficient T2 N0 low-rectal cancer (measuring 2 cm extending 4-6 cm from the anal verge) in a patient who wishes to preserve his sphincter?
Thanks for the question. I think a multidisciplinary approach is key here. First, I would make sure there is an MRI rectal performed confirming the stage of cancer and also clarify whether the patient would like to have organ preservation approach (not only the sphincter but also the rectum itself)....
In a patient with history of recurrent VTE despite anticoagulation, would you consider lenalidomide as part of your initial myeloma regimen?
I would still consider lenalidomide as part of the initial myeloma regimen provided that they were on therapeutic dose anticoagulation (my preference is apixaban 5 mg BID or rivaroxaban 20 mg daily). Ideally, this would be started at least 3 months after therapeutic dose anticoagulation for the most...
In a patient with history of recurrent VTE despite anticoagulation, would you consider lenalidomide as part of your initial myeloma regimen?
I would still consider lenalidomide as part of the initial myeloma regimen provided that they were on therapeutic dose anticoagulation (my preference is apixaban 5 mg BID or rivaroxaban 20 mg daily). Ideally, this would be started at least 3 months after therapeutic dose anticoagulation for the most...
How do you decide when, if ever, to defer pharmacologic venous thromboembolism prophylaxis for hospitalized patients?
For the majority of patients who are not actively bleeding, I use pharmacological prophylaxis. I prefer heparin products, unless they have a history of HIT or religious preferences on porcine products. Even for patients planned for surgery, heparin can always be held or reversed. I prefer LMWH over ...