Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Would a HER2 mutation on NGS of a biopsy of a breast cancer liver metastasis change your management if the met is HER2- by IHC with the initial localized disease being HER2+?
Activating ERBB2 (HER2) mutations can be seen in breast cancer without amplification of the gene in 1-3% of cases, but can be higher in patients who have been treated with hormonal therapy for hormone receptor-positive disease at a higher rate, perhaps 5% or even as high as 10% being reported in lob...
How would you manage a bulky, locally advanced endometrial cancer with extensive parametrial involvement in a patient inoperable due to medical comorbidities?
PET CT staging. If suitable for definitive treatment, EBRT (concurrent chemo if able to get it) plus HDR brachytherapy.
Do you follow GOG, ASTRO, or PORTEC recommendations for adjuvant therapy in stage I endometrial cancer patients?
I believe the current ASTRO guidelines encompass the older GOG and PORTEC guidelines for the most part and we follow these guidelines though we review all for the sake of completeness.For the first patient, barring other risk factors, I would offer adjuvant vaginal cuff brachytherapy; for the second...
Would you consider offering immunotherapy +/- olaparib to a patient with early-stage endometrial carcinoma for whom you are recommending adjuvant chemotherapy based on improved outcomes seen in RUBY/DUO-E/NRG-GY018?
I hesitate to offer the chemo/IO combination to patients with stage I disease as this is likely an overtreatment. The majority of the patients who require chemotherapy for stage I disease are those with serous and carcinosarcoma histology. Most of those patients are not even MMRd. It is unclear what...
Do you recommend stopping olaratumab in patients receiving doxorubicin/olaratumab for treatment of advanced sarcoma?
Yes, we have stopped since this data came out. Am continuing either with single agent doxorubicin or addition of a second agent such as ifosfamide in select patients.
In a patient metastatic recurrent endometrioid endometrial cancer who has a mixed response to carboplatin and paclitaxel, what is your next choice of therapy?
Understanding that there are no head to head trials comparing newer agents after failure of frontline platinum/taxane therapy, it is important to keep some issues in mind. Performance status and toxicity concerns are important given that all treatment will be palliative. 1) Patients should be offere...
How do you integrate ophthalmic exam and surveillance into routine visits for cervical cancer patients receiving tisotumab vedotin?
The key is to identify and intervene early; in my practice, I personally see patients each cycle (q3 weeks) and do office ophthalmic exams. Look for eye redness, irritation, corneal lesions. Key to avoiding tox is prevention with the vasoconstrictor, steroid, and lubricating drops as well as cool pa...
In patients with recurrent MSI-H endometrial cancer on immunotherapy with pembrolizumab, when do you discontinue therapy?
If they have no evidence of disease on their scan, I stop at 2 years.
How do you proceed after a patient has a partial response following 6 cycles of cisplatin + paclitaxel + bevacizumab +/- pembrolizumab for metastatic SCC of the cervix?
For a patient with minimal toxicity and evidence of a partial response receiving pembrolizumab, it is reasonable to continue treatment with chemotherapy + bevacizumab + pembrolizumab for a few more cycles. For patients not receiving pembrolizumab, I would continue treatment until unacceptable toxici...
How will you approach treatment sequencing and use of trastuzumab deruxtecan in hormone receptor-negative, HER2-low breast cancer?
Results from the DESTINY-Breast04 (DB4) trial [1] has created a new therapeutic option for patients with triple negative breast cancer (TNBC) that is low HER2 expressing (IHC 1+ or 2+ but FISH negative). In the DB4 trial, only 11% of participants had hormone receptor negative, HER2 low breast cancer...