Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How would you approach a patient who responded to CDK4/6 inhibitor/endocrine therapy combination for metastatic HR+,HER2- breast cancer who now has disease progression which is biopsy proven TNBC?
If she has no other distant sites of progression through the cdk4/6, then I would continue this post mastectomy. I would only switch if you have new growing distant mets.
Are there clinical features that would lead you to consider combining SBRT + immunotherapy in a high risk early stage NSCLC?
I currently only use SBRT + immunotherapy in medically inoperable, early-stage NSCLC on clinical trial, as it is not yet a standard of care for early-stage disease. There are several randomized phase 3 trials currently testing immunotherapy in this patient population, however. On SWOG/NRG S1914, a p...
Would you consider adding pembrolizumab to adjuvant chemotherapy in a patient with stage 3 TNBC who did not receive neoadjuvant treatment?
It seems that we might be missing some key clinical information here. However, I assume that this was high risk enough - given the ki-67, potentially LN positive, and larger size tumor to make the treating physician concerned. As a first point, while the ctDNA reflects (based on accumulating data) p...
How do you approach a young patient with metastatic poorly differentiated thyroid cancer with rhabdoid/non-anaplastic features?
Unfortunately, this patient has a very poor prognosis. Due to the nature of her tumor being poorly differentiated, her disease is more likely than not to be refractory to radioiodine. If her disease in the thyroid and neck has not been addressed, external beam radiation therapy should be offered for...
How do you manage persistent cytopenias in patients with AML who achieve a complete remission with incomplete count recovery after venetoclax and HMA?
This is an important question. How to manage cytopenias on HMA + venetoclax-based regimens is one of the biggest conundrums in the management of AML. The clinical trials to date have not uniformly answered this question based on level 1 evidence. These recommendations are mainly based on anecdotal d...
How do you manage persistent cytopenias in patients with AML who achieve a complete remission with incomplete count recovery after venetoclax and HMA?
This is an important question. How to manage cytopenias on HMA + venetoclax-based regimens is one of the biggest conundrums in the management of AML. The clinical trials to date have not uniformly answered this question based on level 1 evidence. These recommendations are mainly based on anecdotal d...
What is your approach to evaluation in patients who present with erythromelalgia?
Erythromelalgia is a tough condition to treat. I usually break it down into diagnostic workup and treatment as follows: Diagnostic workup: I usually just get a CBC yearly to look for myeloproliferative disorders. Treatment: I have not had a lot of luck with topicals being too effective, so I usuall...
Would you offer adjuvant pembrolizumab to a stage II-III adenocarcinoma of the lung who had a complete pathologic response to 4 cycles of cisplatin/pemetrexed/pembro (KN-671)?
The question posed is a central question of investigation and debate today.In my view, the patients most likely to derive benefit from adjuvant immunotherapy after receiving neo-adjuvant chemo-immunotherapy are those with the best responses to neo-adjuvant therapy. The patients I would least likely ...
Do you consider ablative radiation therapy for oligometastatic colon cancer with 5 pulmonary lesions responding to chemotherapy?
The definition of oligometastatic colorectal cancer (OCRC) varies quite significantly. The European Society for Medical Oncology (ESMO) defines OCRC as having up to five lesions in no more than three metastatic sites but can sometimes have more if complete eradication is possible. There is no random...
Would you consider adjuvant TDM-1 for a patient with HR+,HER2+ breast cancer with pCR in the breast but N1mic disease post neoaduvant chemotherapy?
The Katherine Trial (NEJM 2019:380;617-280) was a randomized trial of trastuzumab emtansine (TDM-1) versus trastuzumab for patients with residual disease after HER2-directed neoadjuvant treatment. The trial was positive for TDM-1. The randomized patients included those with residual invasive disease...