Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
For a pathologic Stage I squamous cell carcinoma of the oral tongue with negative margins and adequate neck dissection, is perineural or lymphovascuar invasion alone an indication for adjuvant radiotherapy?
I think Dr Eisbruch is spot on- patients with PNI do worse in the surgical literature, but the benefit of XRT in this scenario to obviate recurrence is far from robust. My personal belief is that PNI is not a sign of neurotropism like in melanoma or adenoid cystic ca, but likely another surrogate fo...
Would you consider using luspatercept for a patient with MDS with anemia refractory to ESA/HMA, that has a SF3B1 mutation but without ringed sideroblasts?
A trial of luspatercept would be a reasonable option for this patient. While the phase III studies supporting the use of luspatercept do not represent this patient (MEDALIST Fenaux et al., PMID 31914241 and COMMANDS Platzbecker et al., PMID 37311468), the presence of an SF3B1 mutation does appear to...
Would you consider using luspatercept for a patient with MDS with anemia refractory to ESA/HMA, that has a SF3B1 mutation but without ringed sideroblasts?
A trial of luspatercept would be a reasonable option for this patient. While the phase III studies supporting the use of luspatercept do not represent this patient (MEDALIST Fenaux et al., PMID 31914241 and COMMANDS Platzbecker et al., PMID 37311468), the presence of an SF3B1 mutation does appear to...
What are magic mouthwash alternatives that you would recommend?
Many of our patients will make their own DIY MMW per Phil's My Pharmacist (YouTube) instructions -- uses benzocaine/Cepacol lozenges -- they say it's much more effective than the compounded one from the pharmacy. It is also more economical.If the majority of bothersome mucositis is in the oral cavit...
Do you routinely offer PARP inhibitor maintenance therapy to germline BRCA1/2+, FIGO stage II serous ovarian carcinoma patients after adjuvant chemotherapy?
We are not offering PARPi maintenance in early stage disease at this time. We are in line with the data showing benefit in advanced stage disease. While the data are compelling, you must remember that that these medications 1) have side effects including risk of MDS and 2) can be used in the recurre...
What is your treatment approach for a MSS metastatic colorectal cancer patient who has progressed on FOLFOX and FOLFIRI?
If the patient is RAS/BRAF wildtype, then I would pursue anti-EGFR antibody-based therapy. If the patient has KRAS mutant colorectal cancer and continues to have a good performance status, then I would pursue clinical trials if possible. Many of the clinical trials in this space are phase I or phase...
How do you treat a female with a diagnosis of invasive apocrine carcinoma of the breast?
While some data suggests that apocrine cancers may not respond as well to chemotherapy as ‘usual’ triple negative breast cancers, 80-90% are basal-like by gene expression analysis. I treat them the same way - with adjuvant chemotherapy for Stage I cancers (or Stage II-III patients who didn’t receive...
How do you approach patients with osteosarcoma of the maxilla for neoadjuvant chemotherapy?
The SOC treatment for “jaw” OS is a margin negative surgical resection. If indeed feasible (not always the case), this applies to maxillary tumors. Jaw OS does respond poorly to standard chemotherapy. In our experience, HD Ifosfamide may be a better choice than standard Dox/CDDP. We use this approac...
How would you approach the treatment of checkpoint-inhibitor-mediated temporal arteritis?
Temporal arteritis or GCA is a rare immune related adverse event due to immune checkpoint inhibitor (ICI) therapy. Corticosteroids are the first line treatment, along with holding the ICI. As there have been limited cases, there is not evidence for IVIG in this setting.
For a very high risk prostate cancer with relatively no elevation in PSA but no distant or nodal metastasis would you consider “neoadjuvant” ADT and chemotherapy prior to EBRT?
This is a very challenging scenario in dealing with men who have M0 N0 but very high risk disease with a Gleason 10 (grade group 5) locally advanced tumor. Recent data supports a very poor outcome for these low PSA high grade patients when treated with IMRT and ADT alone (Mahal BA et al Eur Urol 201...