Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How would you treat de novo MET amplified, RAS wt metastatic CRC after progression on standard first-line therapy?
I personally have used tepotinib or capmatinib (completely off label) and have had excellent results (n=2) and sustained response of ~9mo in one and ~12mo in another. Again, this is completely off label and it was after a very serious discussion and goals and outcomes. Both patients are very young, ...
Would you consider upfront immunotherapy in a patient with MSI strongly positive locally advanced adenocarcinoma of the anus versus standard of care?
Great question. For anal and rectal cancers, histology generally supersedes location in determining treatment paradigm, so an anal adenocarcinoma would be treated like a rectal adenocarcinoma (you might consider anal canal involvement T4 staging).Standards of care for MSI-H locally advanced rectal a...
How do you choose bridging therapy prior to CAR-T leukapheresis?
There is a lack of uniform clarity around terminology here. To avoid confusion, I prefer using "debulking" for treatment that is administered prior to T-cell apheresis, and "bridging" for treatment administered after apheresis to bridge the patient during manufacture to maintain disease control prio...
Do you use GCSF for a patient with MDS with excess blasts and neutropenia?
It really depends on what you are trying to achieve: If the goal is to get the patient to a curative allogeneic transplant, then the answer is no. If the goal is to get an elderly frail patient to break fever and leave the hospital to spend some quality time with family, then the answer is yes!
When the initial diagnosis of stage I uterine leiomyosarcoma is made via a non-intact resection such as a myomectomy or supracervical hysterectomy, what factors, if any, might push you to consider adjuvant chemotherapy after completion surgery?
Great question. Delivering a non-intact uterus has been investigated and reported over the past several years. Specifically, it has been reported in the context of uterine morcellation and the prognosis of those surgeries that morcellated sarcomas compared to those that the uterus was delivered inta...
What first-line therapies do you recommend for patients with folliculotropic mycosis fungoides?
Agree with Dr. @Dr. First Last as above. For first-line topical therapies for patients with limited skin disease, you can consider topical steroids or topical nitrogen mustard, although these agents may not penetrate the skin to a sufficient depth to treat the disease at the hair follicle. Other opt...
Do you consider induction immunotherapy or chemoIO prior to chemoradiation for locally advanced PDL-1> 50% NSCLC if normal tissue constraints are not met?
If normal tissue constraints can't be met, or significantly higher chance of distant metastatic disease due to extensive local/regional disease, I would consider induction chemo/IO for patients with negative EGFR, ALK mutation and PD-1>1% before definitive chemo/RT in inoperable stage III NSCLC. Thi...
Is there value to OncoType Dx and/or NGS testing for mutations such as ESR1 in patients who have ipsilateral isolated resectable skin recurrence in ER+ positive low Oncotype breast cancer 10 years after mastectomy and adjuvant AI for 5 years?
I would not order an Oncotype on this tumor if it is a delayed locoregional chest wall recurrence. These LRR events are at higher risk of distant disease and we don't have data on how prognostic or predictive the ODX score is in these scenarios. NGS is also of limited utility but may be helpful if a...
For a patient with localized high risk prostate cancer with high risk Decipher score receiving ADT and abiraterone, is there any value of continuing ADT and abiraterone beyond two years?
Since the trial (STAMPEDE) stopped abi at 2 years, that is the longest duration that I use.In the mHSPC setting, we are seeing many patients stay on their first-line treatment for many years (often longer than 2 years). This has made me more cognizant of the long-term effects of abi/prednisone (acce...
Do you routinely use a bone modifying agent in patients with metastatic RCC with bone metastases receiving a TKI?
Agree. For the most part, I don’t use BMA to treat bone mets as there is a lack of data/representation of RCC patients in BMA studies in solid tumors. With that said, I’ve discussed it in selected cases with disseminated bone mets. Differently, I do offer BMA to treat osteoporosis/osteopenia based o...