Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
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...
When, if ever, would you consider lenvatinib + pembrolizumab as first line therapy for patients with stage IV microsatellite stable endometrial cancer?
Outside of a clinical trial, I have not incorporated lenvatinib and pembrolizumab therapy as 1L therapy for pMMR endometrial cancer patients. This question will be answered by the LEAP-001 trial, which has completed accrual.
In what scenario would you give consolidation chemotherapy after chemoradiation for stage 3 cervical cancer with a good response?
The current standard for stage IIIB cervical cancer is primary external beam radiation + concurrent cisplatin based chemotherapy + brachytherapy (see NCCN guidelines CERV6). Clearly, given the failure rate with distant metastases after primary therapy, there exists significant interest in adjuvant c...
Would you offer any adjuvant therapy for cervical cancer following total pelvic exenteration in the setting of a positive pelvic lymph node?
I am going to "eat a bit of crow" here and admit to having been schooled a bit by the esteemed Dr. @Dr. First Last. I admit to having immediately jumped to the post-rad hyst situation rather than post-exenteration, and I agree that the radicality of the operation could factor into the decision about...
Would you modify standard WPRT+brachy radiation for cervical SCC s/p negative nodal staging but aborted hysterectomy due to previously undetected superficial vaginal disease?
Would treat same with EBRT to 45 Gy in 25 fractions. (Pelvis) With concurrent chemo and brachy.
Do you treat an endometrial cancer that is microsatellite-stable but has a high TMB after progressing on platinum-based therapy with pembrolizumab?
Yes I would. Similarly, I would also treat a patient with advanced cervical cancer with Pembrolizumab. I have a patient with PDL1 negative, TMB-High squamous cell carcinoma of cervix. Submitted to insurance for coverage and she is approved for Carbo-Taxol-Bev-Pembro. It is absolutely worth a try and...
Are there any data that suggest superiority of lenvatinib + pembrolizumab vs platinum-based cytotoxic chemotherapy for advanced or recurrent endometrial cancer?
A pertinent question that we should hopefully know the answer to relatively soon. KEYNOTE-775 did not address this question. However, the LEAP-001 trial, a phase 3 randomized, open-label, study is investigating and comparing the survival outcomes of Pembrolizumab and Lenvatinib vs chemotherapy (carb...
Given the negative results of GOG-0238 but the positive results of the RUBY trial, how do you manage isolated vaginal cuff recurrence of endometrial cancer?
I would favor definitive RT alone and reserve chemo plus IO for systemic or nodal relapse.