Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Given patients with substantial LVSI experience a pelvic recurrence rate of ~25%, how do you counsel patients with stage IA endometrioid endometrial cancer with LVSI regarding the relative risks/benefits of EBRT versus VBT alone?
Updated analysis of PORTEC-1 and 2 noted that 5-year pelvic lymph node recurrence was 26.3% when >4 vessels had LVSI involvement, compared to 6.7% with 1-3 foci and 3.3% with no LVSI1. Based on the data from PORTEC-2 which randomized patients to vaginal cuff brachytherapy or EBRT, on multivariable a...
Will you be changing your management of locally advanced cervical cancer based on the results of the recently published INTERLACE trial?
Absolutely NOT. INTERLACE results are in abstract form only, including early-stage disease I-II at 86%, and the details regarding radiation are minimal, stating it's prescribed to point A and recommend CT/MR planning (we do not know how many patients underwent image-guided brachytherapy). Also, ind...
For patients with advanced endometrial cancer, are the improved outcomes in PFS from DUO-E/RUBY/NRG-GY018 sufficient to move immunotherapy to the frontline for all presuming FDA approval?
The standard of care for metastatic endometrial cancer is systemic therapy with chemotherapy and now with or without immunotherapy. With this approach to therapy, there is a roughly 70% reduction in the risk of progression or death across three separate trials for the dMMR population (RUBY, GY018, A...
Do you have concerns about the validity of the INTERLACE data, considering the long study recruitment period (10 years) and evolution of radiation techniques that have occurred during that time frame?
The long recruitment period and change in the practice of brachytherapy do create some uncertainty in interpretation. As mentioned, 60% had point A-based brachytherapy in INTERLACE. Any modern cervical cancer trial needs to have current technology especially IMRT (helps with nodal boost, conformity,...
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. ...