Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
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...
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.