Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
When do you transfuse cervical cancer patients undergoing chemoradiation?
Although we try to keep hemoglobin 10 gm and above for patients on chemo Rt, it is not clear whether it makes any difference to outcome. Anemia is associated with inferior treatment outcome in cervix cancer, but hemoglobin levels prior to and during treatment are strongly correlated with tumor size,...
For a patient with carcinosarcoma of the uterus and an allergic reaction to paclitaxel, would you have any reservations about using docetaxel instead?
While there is no clear data for this in carcinosarcoma, Yes, I would be comfortable using Docetaxel in this scenario. I am extrapolating from ovarian cancer, where the two drugs have similar activity; The SCOTROC trial in ovarian cancer compared Carbo-Paclitaxel vs. Carbo-Docetaxel and found simila...
Would you recommend maintenance therapy with a PARP inhibitor for BRCA+ patients with advanced uterine serous cancer?
This is a data free zone, so I would hesitate to make a recommendation to use a PARP in this setting. Although, theoretically this should work if the patient has BRCA gene mutation. This would be an excellent question to answer in the form of a clinical trial similar to what Fader et al did for HER2...
How would you manage a patient with history of locally advanced SCC of the cervix, treated with definitive chemoRT, found to have new lung lesions 6 months post treatment?
All patients with metastatic cervical cancer should first be considered for a clinical trial. This is a condition with limited effective treatment options and also disproportionately affects younger women. It is pivotal clinicians be aware of the rapidly evolving landscape of clinical therapies for ...
How do you approach adjuvant treatment for node positive high grade gastric type endocervical adenocarcinoma following radical hysterectomy?
Gastric-type endocervical adenocarcinoma (GEA) was first recognized as a distinct histologic subtype of cervical adenocarcinoma in 2020 by the World Health Organization. Adenocarcinomas account for approximately 25% of newly diagnosed cervical cancer cases worldwide, with GEA comprising around 10% o...
In what circumstance, if any, would you consider fulvestrant + capivasertib over CDK4/6 inhibitors in a patient who has HR+, PIK3CA mutant metastatic breast cancer?
A PIK3CA mutation is prognostic but not predictive for response to a CDK4/6i. The only situation I would consider skipping over CDK4/6i therapy and doing fulvestrant+capi in the 1st line metastatic setting is if the patient had recurrence on adjuvant abema/ribo +AI and NGS showed a PIK3CA mutation. ...
What starting dose of lenvatinib are you ultilizing in recurrent endometrial cancer patients initiating lenvatinib/pembro?
I start with 20 mg daily. I base this on the recent study by Makker and colleagues
How would you approach treatment for centrally recurrent cervical SCC with positive margins after excision that was not exenteration?
We treat with concurrent chemo RT with EBRT plus brachy. Total dose of brachy is based on the extent to residual disease. For positive margin as above with non oncological resection, 65-70 Gy equivalent dose. Would get MRI of pelvis with vaginal gel to assess any residual disease.
What would be your treatment approach for a patient with a new PET positive para-aortic node 3 months following completion of definitive chemoradiation for locally advanced cervical cancer?
My approach would be to treat the entire para-aortic field (above the previous field, obviously) to approximately 45 Gy with conventional fractionation, followed by a boost to the PET positive node to get to a dose of 60 Gy or so, if possible, while respecting the relevant tolerances. If the volume ...
Since the publication of DESTINY-Breast-04 have you implemented new institutional practices for characterization of HER2-low disease given known limitations in pathologist IHC evaluation?
Since the publication of DESTINY-Breast04, new institutional practices for the characterization of HER2-low disease have been implemented in my practice. The Ventana antibody is utilized, with the approved companion diagnostic recommended. However, it should be noted that the study found the Ventana...