Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How do you approach a young patient with undifferentiated pleomorphic sarcoma of the upper extremity who developed ifosfamide-induced nephrotoxicity after two cycles of adjuvant AIM chemotherapy?
In the adjuvant setting, I would suggest to stop further therapy and observe the patient. There is no clear survival benefit with the use of adjuvant therapy. However, I do say this with the knowledge that Sarculator-based analysis of EORTC-STBSG 62931 has demonstrated an OS benefit in patients rece...
Are durva/cis/gem or pembro/cis/gem less efficacious in cholangiocarcinomas with FGFR2 fusions?
I have not been able to find an answer to this question. The NCCN and French National Clinical Practice Guidelines both continue to recommend first line treatment with Gemcitabine/Cisplatin and Durvalumab. Exceptions include NTRK gene fusions and MSI-H/dMMR where NTRK inhibitors (e.g. entrectinib, l...
Do the results of CheckMate 451 (nivo-ipi or nivo maintenance after chemotherapy in patients with SCLC) raise any questions for you about the role of immunotherapy in SCLC as established by the CASPIAN and IMpower 133 trials?
The results of the Checkmate 451 trial evaluating nivolumab and ipilimumab or nivolumab maintenance versus no maintenance following front line chemotherapy for extensive stage small cell lung cancer help put the CASPIAN and IMpower 133 trials using front line chemotherapy with immune checkpoint inhi...
Do you get routine MRI brain for surveillance on patients with history of stage III melanoma?
Unfortunately, this is an area that doesn't have a lot of data to support recommendations. It is rare to develop CNS/brain metastasis as the only site of metastatic disease (~5% of metastatic patients). Therefore, I try to get an annual MRI brain for stage IIIB-IIID (resected) patients, especially i...
How do you manage steroid-refractory acute GVHD following allogeneic transplant?
The short answer is to enroll the patient in a well-designed clinical trial, if available. If not, I would start with ruxolitinib based on the REACH2 trial (Zeiser et al., PMID 32320566) which was multicenter, randomized, open-label, phase 3 trial comparing the efficacy and safety of oral ruxolitini...
How do you manage steroid-refractory acute GVHD following allogeneic transplant?
The short answer is to enroll the patient in a well-designed clinical trial, if available. If not, I would start with ruxolitinib based on the REACH2 trial (Zeiser et al., PMID 32320566) which was multicenter, randomized, open-label, phase 3 trial comparing the efficacy and safety of oral ruxolitini...
Can you safely proceed with breast irradiation during treatment with immunotherapy?
In KEYNOTE-522, RT was done with concurrent Pembro after NACT plus IO and no significant additional untoward effect was reported. So, we do RT routinely with Pembro for these patients.
What would be your regimen of choice for a healthy 80+ year old with localized triple negative breast cancer?
My inclination would be to avoid administering an anthracycline to such a patient, as long as you include a taxane and carboplatin in her treatment regimen. If you're treating her in the neoadjuvant setting, Sharma and colleagues achieved a similar pCR rate with every 3-week docetaxel and carboplati...
Do you try to incorporate mFOLFIRINOX in total neoadjuvant therapy for rectal cancer?
PRODIGE 23 study is an open-label, randomized phase 3 study (Conroy et al., PMID 33862000). Locally advanced rectal cancer patients (cT3 or cT4 M0) were randomized to either the study arm (mFOLFIRINOX X 3 months, chemoradiation, TME, FOLFOX X 3 months) or the standard arm (chemoradiation followed by...
For multiple myeloma, is 8 Gy in 1 fraction an appropriate palliative dose, although this histology was excluded from trials examining a single fraction?
There was a randomized trial comparing 8 Gy/1 fx vs 30 Gy/10 fx for patients with multiple myeloma. There was no difference in analgesic response or recalcification, however patients with the protracted regimen seemed to have a benefit in terms of QOL. However, the the control arm (30 Gy in 10), th...