Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
With the recent approvals of CAR-T for second-line therapy in myeloma, does this change your approach to use of consolidative autologous transplant or autologous transplant as second line therapy?
This is an excellent two-part question, and hopefully one where we'll continue to see more data year by year!The second question (ASCT as second-line therapy) is easier to answer - in brief, I no longer recommend this. Extrapolating from first-line consolidation to second-line salvage ASCT (i.e., f...
With the recent approvals of CAR-T for second-line therapy in myeloma, does this change your approach to use of consolidative autologous transplant or autologous transplant as second line therapy?
This is an excellent two-part question, and hopefully one where we'll continue to see more data year by year!The second question (ASCT as second-line therapy) is easier to answer - in brief, I no longer recommend this. Extrapolating from first-line consolidation to second-line salvage ASCT (i.e., f...
How do you approach adjuvant treatment of non-uterine leiomyosarcoma?
I do not offer adjuvant chemotherapy to persons with leiomyosarcoma. One can make a case that the large negative randomized study EORTC 62931 published in 2012 supplants the 2008 meta-analysis of smaller studies that showed survival benefit from adjuvant chemo. Woll et al., PMID 22954508Neither is t...
How would you approach adjuvant therapy for a patient with duodenal adenocarcinoma with ypT3 pN2 disease on Whipple resection after neoadjuvant FOLFOX x6?
I would offer postoperative chemoradiation. Duodenal primary cancers have more of a significant locoregional pattern of spread so logically, local control improvement could translate to a survival benefit.
Would you consider adjuvant osimertinib for patients with non-classical but sensitizing EGFR mutation positive NSCLC s/p surgical resection?
While uncommon, EGFR mutations were not included in the ADAURA trial (and thus may not be covered by 3rd party insurance), I will consider using osimertinib in the adjuvant setting for high risk patients with certain atypical/uncommon EGFR mutations, i.e. mutations wherein structure-based modeling a...
Is there a preferred chemotherapy regimen for chemo-mobilization prior to HDCT for a patient with NSGCT with prior BEP and TIP?
In general, at most high-volume institutions, there is little utilization of mobilizing chemotherapy prior to high-dose chemotherapy. Stem cell collections seem to be accomplished without standard dose chemotherapy in most cases.
Would you ever consider definitive thoracic RT with concurrent immunotherapy in Stage III NSCLC?
Generally speaking in my opinion, concurrent chemoradiation with a platinum drug doublet remains standard of care outside of clinical trials. Definitive chemoradiation in stage III lung cancer is considered a curative regimen despite the risks of local recurrence (around 30%) and distant mets. Bear ...
How do you treat metastatic adenoid cystic carcinoma of breast primary, ER 3%, PR, HER 2 negative with liver only metastasis?
Adenoid cystic carcinoma of the breast is a very rare breast cancer type accounting for about 0.1% of all breast cancer cases. There is a paucity of prospective trials in this very rare tumor type. Adenoid cystic carcinoma is not typically considered to be chemotherapy-sensitive as it grows very slo...
How do you decide between treating with neoadjuvant nivolumab/ipilimumab versus neoadjuvant pembrolizumab for patients with resectable, clinical node + Stage III melanoma given the NADINA trial results?
The NADINA trial (NCT04949113) has clearly established that the neoadjuvant approach affords a better EFS in patients with clinical stage III melanoma. However, there is no direct comparison between anti-PD1 monotherapy and dual checkpoint inhibition in the neoadjuvant setting. I do not think that s...
Can docetaxel be safely given to patients with hyperbilirubinemia from Gilbert’s syndrome?
Docetaxel can be safely administered at full doses in patients with Gilbert's Syndrome. These patients usually have a variant in the UGT1A1 gene. While it can cause issues with some oncologic therapies (especially ones that rely on UGT-1A - the classic being irinotecan), it does not seem to affect t...