Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
In a patient with early stage HER2+ breast cancer s/p surgery, would you consider a noncytotoxic chemotherapy approach with anti-Her2 therapy alone if the PS is borderline and/or patient declines chemotherapy?
We now have evidence from several prospective clinical trials enrolling elderly patients and patients who were not fit to receive chemotherapy demonstrating that single agent adjuvant trastuzumab treatment is active and offers a reasonable treatment option without any significant risk of cardiac tox...
In what situations would a standard FDG PET/CT be useful in the evaluation of high risk prostate cancer?
Overall, my impression is that the use of FDG PET for this purpose is limited. If interested, below is my rationale as summarized in the Conclusion.As mentioned, PSMA PET/CT is considered by many to be the current best standard of care for the staging evaluation of high-risk prostate cancer, and it ...
Would you consider a patient with DLBCL to have CNS involvement if no brain lesion is seen on imaging, CSF flow cytometry is negative, but PCR is positive for MYD88 and KMT2D mutations?
Cerebrospinal fluid (CSF) is an ultrafiltrate of plasma contained within the ventricles of the brain and the subarachnoid spaces of the cranium and spine. It is possible that cfDNA fragments containing MYD88 and KMT2D mutations may have found their way into the CSF and thereby detected by PCR techni...
What is the recommended approach for systemic therapy for patients with locally recurrent p16-positive SCC of the oral cavity who are not candidates for resection or re-irradiation?
The recommended regimen would depend on the PD-L1 (CPS) score and would be guided by recent clinical trials, particularly KEYNOTE-048 and KEYNOTE-B10.The KEYNOTE-048 trial has established pembrolizumab as a preferred first-line treatment option. While monotherapy for CPS-positive patients could be c...
Should we be performing sentinel lymph node biopsies for HR+ patients ≥70 years of age?
I do not think that the monarchE data for adjuvant abemaciclib warrants changing our standard practice around omission of SLNB for patients >/= 70 yo with low-risk HR+/HER2- tumors that are clinically node-negative, because adjuvant abemaciclib is largely only appropriate for higher risk tumors and ...
What dose and fractionation would you deliver to the sole of the foot in a patient with multifocal cutaneous DLBCL that is resistant to systemic therapy?
We need some more information here. Does multifocal mean the patient has multiple skin lesions? The diagnosis of cutaneous DLBCL is also somewhat ambiguous. Is this cutaneous DLBCL leg type, a specific entity in the WHO pathology classification, or perhaps the older WHO classification is being used ...
Is it acceptable to use TCHP instead of AC-T + trastuzumab as neoadjuvant chemotherapy for HER2+ inflammatory breast cancer?
Yes. With the Neosphere trial demonstrating an impressive PCR rate for the TCHP regimen, the TRAIN-2 trial showing no difference in outcomes with anthracycline containing vs non-anthracycline regimen and the BCIRG-006 trial long term follow showing that only 7 DFS events separating AC-TH and TCH, I ...
What are your top takeaways in GI Cancers from ESMO 2024?
Re: the IMbrave050 trial: It was perhaps not unexpected, but still disappointing, to see the trial did not meet its primary endpoint of improvement in RFS. It would be interesting to see if there is a signal in preventing late recurrences, as we know there are two groups of patients: those that rec...
Do you recommend concurrent cisplatin and gemcitabine with radiotherapy for unresectable vulvar cancer, as described in GOG-279?
We are still doing weekly cisplatinum with a higher dose of RT as there is concern about additional morbidity with the addition of gemzar. Richman et al., PMID 32981696
What is the utility of granulocyte infusions in patients with neutropenia and severe infection?
Granulocyte transfusion is infrequently used for septic neutropenic patients given that the randomized trial (RING) that looked at this question did not show improved outcomes (with the caveat that the trial did not finish accrual (Price et al., PMID 26333778). Having said that, the criteria to cons...