Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
For a patient with ENKTL nasal type (nose/sinus involvement) who has hepatic toxicity with pegasparaginase but a CR after 2 cycles of chemotherapy with a plan for "sandwich" radiotherapy - what, if any, chemotherapy would you resume after completion of radiation?
This is an interesting situation as there is not much data. The cure rate is high for early-stage disease after chemoradiation, even with VIPD and no asparaginase regimens (see de Pádua Covas Lage et al., PMID 36446856). Nature reviews which show in Table 2 survival curves similar for asparaginase r...
Would you continue or switch therapy for someone who progressed through AR directed therapy and has a rapid rise in PSA while receiving Ra-223 for bone-dominant castrate resistant prostate cancer?
Certainly, it is reasonable to stop an AR inhibitor that is no longer clinically benefiting a patient irrespective of the use of concurrent radium-223, particularly a second AR inhibitor if there is no evidence of a response. Cross resistance between AR inhibitors is common and a rapid PSA rise sugg...
How do you reason the risk and benefits of low dose vaginal estrogen to a patient on an AI for postmenopausal breast cancer that is suffering from symptomatic vaginal atrophy?
At our Center, we have step-wise approach to vaginal dryness/dyspaurenia. First, establish whether the vaginal dryness is problematic. Most often, the vaginal dryness in-of-itself does not cause problems that impact quality-of-life. The major problem is painful intercourse. Step 1 is the non-hormona...
Would you consider the use of EGFR inhibition (cetuximab/panitumumab) in first line in metastatic right-sided RAS/RAF WT colon cancer, if bevacizumab contraindicated?
This is an area where I’ve seen practice patterns diverge amongst practitioners, even within the same institute, and has been subject to some lengthy discussions within our tumor boards. For me, the short answer is that in general, no, I would not give anti-EGFR to a patient with a right-sided tumor...
Is there a role for intravenous temozolomide in place of oral for the 5-day dosing q 28 days after surgery/XRT+Temozolomide for glioblastoma multiforme?
I have never used IV temozolomide, or seen it used by others in practice for GBM, and do not think it would offer a significant benefit over oral formulations as it has high oral bioavailability. I have seen and prescribed liquid oral temozolomide for patients with dysphagia.
Do you give bisphosphonates after completing adjuvant anti-HER2 therapy and chemotherapy for HER2+ breast cancer to reduce the risk of recurrence?
Bisphosphonates and the RANK-ligand inhibitor, denosumab, are bone-modifying agents that are indicated to decrease the risk of bone fragility fractures in at-risk populations without cancer, and to decrease pain and complications related to metastatic bone disease. In the adjuvant setting for postme...
Do you offer adjuvant bisphosphonates to high-risk premenopausal women on ovarian suppression for early-stage breast cancer who would want to consider pregnancy in the future?
ASCO guidelines from 1/2022 recommend a discussion of bisphosphonate therapy in post-menopausal women or women on ovarian suppression who are candidates for adjuvant therapy, but risks and benefits should be carefully weighed.In a large meta-analysis of adjuvant bisphosphonate therapy in early breas...
What criteria would you use to decide between trastuzumab-deruxtecan and sacituzumab govitecan in HER2 low metastatic TNBC given T-DXd approval in HER2 low breast cancer?
There are currently unfortunately no biomarkers to select participants for antibody drug conjugate therapies, including sacituzumab and trastuzumab deruxtecan for HER2 low metastatic TNBC. The studies evaluating sacituzumab govitecan and trastuzumab deruxtecan had different I/E criteria, including w...
How often do you assess for frailty in your clinical practice for patients with Multiple Myeloma and what tool do you use?
Excellent question - the short answer is that I suspect the "eyeball test" is used by the vast majority of people reading this, to the point where launching a Mednet poll might not even be helpful...For those who are interested in trying out the IMWG frailty score, it's available (for free) at this ...
Would you start anticoagulation in a patient with RCC and related (tumor) thrombus with extension to renal vein and further?
Tumor thrombus is an intraluminal extension of tumor mass, rather than a true thrombus. There is no evidence that anticoagulation improves outcomes in tumor thrombus (Marcoux et al., Blood 2019). Primary management is surgical resection, typically as part of radical nephrectomy for localized RCC or ...