Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How do you choose first or second-line systemic therapy for fibrolamellar hepatocellular carcinoma?
Fibrolamellar carcinoma is histologically unique from hepatocellular carcinoma. The disease is correctly called fibrolamellar carcinoma, and not fibrolamellar hepatocellular carcinoma, or hepatocellular carcinoma fibrolamellar variant. Even though the latter may be permissive if the lack of cirrhosi...
Should we consider deferring adjuvant chemotherapy for resected early-stage NSCLC in light of COVID-19?
This is a great and timely question! The absolute benefit observed with adjuvant chemotherapy in surgically resected NSCLC is greatest in those patients with stage II and III disease. The question is how long can one wait to give adjuvant chemotherapy and maintain its benefits. Salazar and colleague...
What is your approach for endocrine therapy in young women (<35 years old) with HR+/HER2+ breast CA with residual disease after TCHP who will start adjuvant T-DM1?
She would be given the options of tamoxifen or ovarian suppression with an AI for five years and then a discussion at that time based on where the data goes in that time. Tamoxifen would have fewer side effects but less effective reduction of PFS per extrapolation from the SOFT/TEXT trials. Ovarian ...
How do you counsel patients on the risks and benefits of chemotherapy or radiation offered with palliative intent?
Before I start counseling a patient on these decisions, I want to know a few things first. I would want to know from the oncologists what they think the benefits are (i.e., how much more time might they get? Symptom control?) and what the risks are. The chances that the patient will see a benefit. ...
How has COVID-19 altered your recommendations for invasive mediastinal staging for NSCLC?
I just had this discussion with our chief of interventional pulmonolgy at MD Anderson. Some of his faculty are being asked to staff our COVID-19 patient floor. In addition, bronchoscopy procedures should be considered high-risk procedures, and are required to have at least 45 minutes in between proc...
How do you approach a stage IIIC triple positive IDC, s/p neoadjuvant TCH and P, lumpectomy, and ALND with significant residual disease at the time of surgery?
I would use adjuvant T-DM1 for residual disease after standard neoadjuvant therapy for HER2+ breast cancer as described in this case. We have strong evidence from the KATHERINE randomized trial that adjuvant T-DM1 compared to trastuzumab that cuts recurrence risk by about 50% in this situation. Whil...
In what clinical scenario would you consider liver transplant evaluation for a patient with sickle cell hepatopathy?
We have evaluated and transplanted patients with sickle cell hepatopathy with severe liver dysfunction but well-controlled sickle cell. These patients will typically have jaundice, coagulopathy, and biliary strictures. They should not have significant extrahepatic complications of the hematologic di...
How many days do you hold osimertinib during or around SBRT for oligometastatic EGFR mutated advanced lung cancer?
This a great question and a common clinical scenario that we are all confronted with. Stereotactic body radiation therapy (SBRT) is being increasingly used for oligometastatic progression of EGFR mutant NSCLC. The theoretical risk of combining EGFR inhibitors and radiation therapy would be an enhanc...
What scenarios, if any, are you delaying adjuvant chemotherapy in light of the COVID-19 outbreak?
This is a complex issue that our group here at MSKCC is dealing with right now, with formalized guidance pending. This is in mind of the fact that the mortality rate in Chinese patients with cancer approached 6%. While I wouldn't delay starting adjuvant therapy—which is being given with curative int...
Are there still clinical situations in which you deliberately treat patients with a DOAC besides apixaban?
Thank you for your question. Apixaban has been my preferred agent for a long time for patients requiring therapeutic anticoagulation. Apixaban’s lower bleeding risk was shown prior to and now has additional evidence to support this with the COBRRA trial. The risk is also ameliorated by the safety in...