Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Would you consider a treatment break for a patient with metastatic urothelial carcinoma who achieved a near-complete response to enfortumab?
The answer to this question is highly dependent on the specific clinical context. However, for a patient who has a deep and durable response to enfortumab vedotin monotherapy and has been on treatment for a prolonged period of time (again context-dependent, but at least a few months), I think it is ...
Would you consider definitive chemoradiation followed by surgery for esophageal adenocarcinoma with a single distant metastatic site?
The management of oligometastatic esophagogastric cancer is a controversial and evolving topic. For many years, our disease management team (DMT) shied away from such an approach, in large part because of the results of the phase III REGATTA study (Fujitani et al., PMID 26822397). This Japanese stud...
What is your approach to managing follicular lymphoma with central nervous system involvement?
Not really an expert on this issue. Fairly uncommon to have a follicular lymphoma-associated CNS disease. Our usual is for high-dose methotrexate, Temodar, and rituximab. Potentially followed by autologous stem cell transplant.
What is your approach to managing follicular lymphoma with central nervous system involvement?
Not really an expert on this issue. Fairly uncommon to have a follicular lymphoma-associated CNS disease. Our usual is for high-dose methotrexate, Temodar, and rituximab. Potentially followed by autologous stem cell transplant.
Is Oncotype testing useful in variant histologies such as micropapillary breast cancer?
I have no idea whether Oncotype testing is predictive of benefit to chemotherapy in micropapillary breast cancer, which is a rare variant. Micropapillary variant tends to worse prognosis and greater degree of nodal positivity in some studies. However, in other studies, the prognosis is similar to in...
Would you change systemic therapy in a patient with SCLC with stable systemic disease but CNS progression?
Since the patient has well-controlled extracranial disease, I would continue lurbinectedin. As the new intracranial lesions are potentially treatable with SRS, I would favor that approach for this patient.
How do you manage anticoagulation in a patient with DVT from likely malignant mechanical obstruction?
This is a very difficult situation to manage. Would promptly initiate therapeutic anticoagulation as long as no increased risks for bleeding. The surgery to remove the uterine mass is likely urgent. I would confirm with gynecologic oncology (or the team planning on removing the mass) that it is not...
How do you manage anticoagulation in a patient with DVT from likely malignant mechanical obstruction?
This is a very difficult situation to manage. Would promptly initiate therapeutic anticoagulation as long as no increased risks for bleeding. The surgery to remove the uterine mass is likely urgent. I would confirm with gynecologic oncology (or the team planning on removing the mass) that it is not...
When should a biopsy be obtained to rule out small cell transformation in a patient with stage IV NSCLC and an EGFR mutation?
Histologic transformation is a well-described but poorly understood - and under-diagnosed - mechanism of resistance to TKIs. The best known is small cell transformation in EGFR mutant NSCLC but transformation, to either small cell or squamous cell, has been seen with multiple different TKIs. Biopsy ...
For patients with Stage IIIB or IV HD flowing Bv-AVEPC with initial large mediastinal adenopathy, how can we avoid ISRT?
It is true that on the clinical trial AHOD1331, patients who presented with large mediastinal adenopathy received radiation therapy as did patients who were slow early responders (Deauville 4 or 5 after two cycles of therapy). It is noteworthy that 3-year event-free survival was extremely high for a...