Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How would you approach patient with known Lynch Syndrome who developed a gall bladder cancer which on pathologic testing of the tumor by PCR and immunohistochemistry is pMMR and MSS?
Assuming advanced/metastatic disease, for MSS disease, I would use frontline chemoimmuno therapy with cis+gem+durva/pembro. In this case, response to immunotherapy alone may not be comparable to MSI-high disease thus, hesitant to use pembro alone.
Which adjuvant chemotherapy would you offer to a MSI high pancreatic cancer patient after Whipple?
Not yet ready for IO alone. Can add IO to FFX maybe.
After seeing results from GOG238, is there a subset of patients that might still benefit from chemoradiation for centrally recurrent endometrial cancer?
It’s hard to know who would benefit but use for bulky or high grade central recurrence. Bulky is subjective but usually for lesions that are more likely to need interstitial brachytherapy.
How would you manage a patient with NLPHL and CKD who relapsed after a long disease free interval (i.e. 7 years) following bendamustine?
I honestly might consider BR again depending on the counts. I personally use as little as possible - often stopping the B after 3-4 cycles if the patient is in remission.
Do you treat patients with resected adenocarcinoma of the intrapancreatic bile duct along a biliary paradigm or pancreatic paradigm?
I doubt this distinction can be made with any accuracy. In this anatomic site, the differences between pancreatic, biliary, and ampullary carcinoma are extremely difficult to differentiate based on any objective criteria. Therefore, the best approach is to make a diagnostic estimation and consider t...
Is there a role for Elacestrant in ER+ metastatic breast cancer with ESR1-YAP1 fusion on NGS?
It depends on the specific details of the fusion protein and where the fusion breakpoint is. Also, the clonality of the fusion may play a role too. There are reports of a stable in-frame ESR1 e6 YAP1 fusion protein that has the ESR1 DNA binding/nuclear localization domains but the ligand binding dom...
In patients with resected PDAC treated with adjuvant FOLFIRINOX who recur from 1-3 years post completion of adjuvant therapy, do you consider retreatment with FOLFIRINOX or gemcitabine/nab-paclitaxel in the absence of a clinical trial?
One can use either depending on how long after adjuvant completion date although I will lean towards gem/nab-paclitaxel more. But could be either depending on PS, preexisting neuropathy, patient preference, age, site(s) of recurrences, as important considerations. an asymptomatic lung recurrence, tw...
Is it possible to give Inotuzumab ozogamicin in the front line setting for an older patient with Ph- Pre-B-ALL?
Yes - there are encouraging data from early-phase trials looking at InO-containing regimens in the frontline setting. Some of these include: Alliance A041703 (InO followed by blinatumomab for older adults with CD22+, CD19+, Ph-negative B-ALL): Wieduwilt et al., Journal of Clinical Oncology 2023, sup...
What is the optimal sequence of available therapies in patients with BRCA+/HRR mCRPC after progression on first line combinations?
We have data that chemotherapy is generally superior to next-line ARSI. However, we are still lacking definitive data on sequencing chemotherapy and PARPi. Based on my clinical experience and what can try to learn from studies regarding the toxicities of chemotherapy and PARPi, I believe that PARPi ...
For a pedunculated rectal polyp found to be adenocarcinoma after endoscopic removal, with PNI as the only adverse feature, would you recommend additional treatment such as surgery or chemoradiation?
Yes