Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
What is your treatment approach for a pediatric patient with uterine embryonal rhabdomyosarcoma found after removal of a prolapsing uterine mass, with no evidence of distant metastasis on imaging?
Based on the location of the uterus, this would be a favorable site. In the scenario presented, the tumor is noted to be removed, but the margin status is not noted, which could greatly affect the approach. Also, the exact uterine location (such as cervix vs body of the uterus) may make a difference...
What would be a reasonable radiation approach and dose for a patient with multiple myeloma with brain involvement?
I would first wish to clarify what is meant by "brain involvement."When plasma cell neoplasms of the brain occur, they are usually the result of significant marrow involvement of calvarium and/or skull base with focal intracranial extension, or plasma cell infiltration of the leptomeninges and dura....
How do you manage leptomeningeal carcinomatosis from a metastatic solid tumor?
Several factors are usually considered prior to deciding how to manage patients with leptomeningeal carcinomatosis from a metastatic solid tumor. These factors are tumor type, performance status, neurological status, the bulk of CSF disease, the extra-cranial tumor burden as well as the chance of th...
What adjuvant treatment would you use in a pT1miN0M0 ER -/HER2 IDC of the breast after bilateral mastectomies?
I generally would not treat microinvasive disease with systemic therapy unless it were multifocal in a surrounding of high grade DCIS, as these cases could recur distantly, although even then, the risk is low. It may be higher over a life time in younger patients - with 20 year breast cancer mortali...
How aggressive would you be in irradiating asymptomatic bone metastases in a patient with metastatic prostate cancer?
I used to tell patients who were referred to me for asymptomatic bone mets to defer treatment until they began having pain (unless there was an impressive radiographic lesion or concerns of impending pathologic fracture or cord compression). But the multicenter, randomized trial presented at the Ame...
What is your preferred third line treatment option for metastatic NSCLC after first line chemo-immunotherapy and second line single-agent chemo (assuming no actionable mutations)?
What a question! One that has no answer, I'm afraid. This is exactly where we were five years ago before the advent of immunotherapy as a treatment for NSCLC. Then -- as now -- the best answer for a patient with a good performance status was a clinical trial. If for whatever reason a clinical tria...
How would you approach a clinical stage 3 sigmoid colon cancer, dMMR/MSI-H with comorbidities and increased risk of surgical complications?
For patients with dMMR/MSI-H clinical stage III sigmoid colon cancer, the current practice would be upfront surgery, and usually, most patients should be able to tolerate the minimally invasive surgical approach. If the patient is not a surgical candidate due to comorbidities with increased risk of ...
Is there data to support a 3 weeks regimen of panitumumab with maintenance capecitabine in colon cancer?
Although the most commonly used dosing for panitumumab is 6 mg/kg every 2 weeks, the serum panitumumab concentration was similar in the 2.5 mg/kg weekly, 6.0 mg/kg every 2 weeks, and 9.0 mg/kg every 3 weeks in the phase 1 study (Weiner et al., PMID 18223225). A phase 2 study using panitumumab and ir...
Would you treat an unresectable MSI-H colon cancer patient with persistent hepatitis C with immunotherapy?
Great question.There are two questions here:Question 1. Should we treat an unresectable MSI-H colon cancer patient with immunotherapy? The answer is yes, based on the data we have from metastatic disease trials such as KEYNOTE-177 and CheckMate 142 studies. We can also use the phase 2 study data fro...
How do you treat refractory cold agglutinin disease?
If the patient has refractory cold agglutinin disease not associated with malignant lymphoproliferative disease, I have used intermediate dose Cytoxan. However, there is recent evidence that inhibition of C1s and thus complement activation by a monoclonal antibody sutimlimab markedly reduces hemolys...