Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How would you manage a cervical cancer patient with bulky PA LNs with direct extension and/or invasion into the lumbar vertebral bodies?
I would treat with definitive intent. May do chemo IO first and then definitive chemo RT.
Would you offer adjuvant therapy following successful resection of a solitary lung recurrence of leiomyosarcoma if no other evidence of recurrent disease on PET CT?
It is reasonable to observe this patient if no evidence of other disease and surgical margins were obtained, however, many would offer adjuvant chemotherapy or radiation to the bed of the resection. If the patient had a prior treatment at the initial diagnosis, another sarcoma chemotherapy regimen c...
What is trastuzumab deruxtecan's activity for patients with CNS+ disease?
The DESTINY-Breast04 trial excluded patients with active CNS metastases so the study does not provide information on the activity of this drug in HER2-low CNS disease. In HER2-positive disease, however, CNS activity has been observed with trastuzumab deruxtecan; among patients evaluated for CNS resp...
What is your approach to the adjuvant treatment for stage IA grade 2 endometrioid adenocarcinoma without LVSI whose molecular classification is p53 abnormal (MMR intact, POLE wild type)?
These attached guidelines recommend consideration of chemo if IA with myometrial invasion. From a radiation perspective, I do brachy alone with consideration of chemotherapy. Concin et al., PMID 33397713
What are your top takeaways from SGO 2023?
There were many great presentations at SGO 2023 along with a few practice changing presentations. Two pivotal randomized phase III clinical trials enrolled advanced, metastatic endometrial cancer patients. Each demonstrated dramatic benefit with the addition of immunotherapy to chemotherapy (followe...
How do you sequence everolimus/endocrine therapy versus fam-trastuzumab deruxtecan after progression on CDK4/6i in metastatic ER+ HER2 low breast cancer?
Since the DESTINY-Breast04 trial required patients to be endocrine therapy resistant and have received 1-2 prior lines of systemic chemotherapy for metastatic disease, I would consider Enhertu only after patients progressed on everolimus and endocrine therapy.
For a patient with IIIC endometrial adenocarcinoma diagnosed and treated with 6 cycles of Carboplatin/Paclitaxel two years prior, would you consider maintenance therapy with PD-L1 inhibition, given results of GY018 and RUBY?
Endometrial cancer incidence is increasing in the United States, and very little improvement in survival has been noted for advanced disease until recently. Monotherapy with immune checkpoint inhibitors have offered hope for patients with recurrence, and the recent publication of GY018 and the RUBY ...
How would you manage a Stage IB endometrioid endometrial cancer, status post staging surgery, with a rapid vaginal recurrence <1 month post operatively?
A rapid recurrence like this is unusual, but we have definitely seen it. Cuff recurrences require multidisciplinary management. The most worrisome feature of this patient is the rapidity of recurrence. For the initial management, I would probably have recommended some kind of adjuvant treatment afte...
What chemotherapy regimen would you utilize for a metastatic, poorly differentiated carcinoma of the cervix with neuroendocrine features?
I would work with pathology to define if this is a true neuroendocrine cervical cancer versus a poorly differentiated cervical carcinoma with neuroendocrine features. This could potentially impact treatment decisions. I treat patients with poorly differentiated metastatic cervical carcinoma with the...
What are your top takeaways from SGO 2022?
So many great presentations at SGO 2022! The depth of the science was amazing and the ability to co-mingle in person with new friends and colleagues was more than fabulous. Although I am asked to discuss 3 pivotal abstracts, I encourage all readers to review the many great presentations via the “OnD...