Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
What are the treatment options for relapsed T-ALL in a patient who was nonadherent with AALL and hyper-CVAD regimens?
Regimens to consider with data for R/R T-ALL include: Nelarabine +/- chemotherapy. There are retrospective data to support adding nelarabine to a chemo backbone (Shimony et al., PMID 36508268 and Shimony et al., PMID 37389830). HMA + venetoclax (Pinton et al., PMID 37889114 and Cao et al., Blood 202...
Are there situations for which you consider concurrent chemoradiation for breast cancer patients?
Most of the experience with concurrent chemoradiation for breast cancer comes from the era of CMF chemotherapy. One of the rationales for delivering RT concurrent with CMF was to avoid delaying radiation for 6 months. In many cases methotrexate was dropped for the cycle overlapping with RT, or RT wa...
How would you treat an advanced stage small-cell carcinoma of the ovary, hypercalcemic type? (SCCOHT)?
Small cell carcinoma of the ovary hypercalcemic type (SCCOHT) is an exceptionally rare tumor affecting patients from infancy to at least the fifth decade of life. SCCOHT tumors are characterized by mutations of the SWI/SNF member SMARCA4 that encodes BRG1. Given the rarity of SCCOHT, limited prospec...
Are you offering durvalumab to patients with Stage III NSCLC with known targeted mutations (ie ALK, EGFR, ROS1, BRAF) after completion of chemoradiation per PACIFIC?
The PACIFIC study represents an important advancement for patients with unresectable, stage III NSCLC. The initial OS results were presented recently and demonstrated a significant improvement in survival for patients receiving durvalumab following chemoradiation. The median time has not been reache...
How do you decide between a PARP inhibitor or alpelisib for patients with metastatic ER+, gBRCA+, PI3K mutated breast CA with progression on CDK 4/6 inhibitor/fulvestrant?
There is preclinical data that blockade of pik3ca/mtor pathway can sensitize cancer cells to PARP inhibitors by inhibiting homologous repair (Ibrahim et al Cancer Discovery 2012). We published case series data for our patients treated on the BROCADE trial showing a tripling of PFS for BRCA2+ ER posi...
How stringent or flexible are you with concurrent chemotherapy and radiation starting on the same day in the definitive CRT setting for HN patients?
I am OK with RT starting a day or two after chemo, usually we may need some extra time planning and doing the vsim, shouldn't really be a big deal with RT starting a little after since the chemo is a sensitizer and it will already be in the patients system when we start RT
How quickly do you expect iron stores to decrease after starting iron chelators?
This is a complex answer to what seems like a simple question. It is not a standard rate of decline because each patient's situation is different. It is always about the balance of how much iron is going in vs. how much iron is being excreted. Essentially there are 4 variables that must be considere...
How do you approach rising PSA many years after prostatectomy with negative PSMA PET?
The devil is in the details. What is the status of the patient? In other words, what is the expected survival of the patient given his age, performance status, and medical conditions? There are online calculators that can be used to help. At what PSA value was the PSMA scan obtained? The utility of ...
Given the current COVID-19 pandemic, how long would you delay mastectomy post neoadjuvant chemotherapy?
Consideration should be given to perform surgery for post neoadjuvant patients no later than 8 weeks. No difference for subtypes. Sanford RA et al reviewed the MD Anderson breast cancer database for stage 1-3 patients undergoing neoadjuvant chemotherapy between 1995-2007: a sensitivity analysis comp...
How would you manage a borderline resectable pancreatic cancer s/p induction chemo + chemo-RT who was unable to go to surgery?
Tough situation. If there was stable/slight progression of disease at 6 months, I would not be inclined to offer reirradiation at that time. If any possibility of radiographic stability, tumor markers were stable, and the patient was clinically well, I would continue with close surveillance. If clea...