Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Would you treat the prostate in a patient with widely metastatic disease who has CR to all metastatic sites after systemic therapy or ADT?
This is an interesting hypothesis, but requires further study before offering. The trials that define a benefit to prostate RT in the metastatic setting (HORRAD, STAMPEDE, and now PEACE-1) did not use response-adapted selection criteria. Therefore, we cannot say that radiation to the prostate in an ...
For a patient with a lung tumor that is radiographically consistent with early-stage NSCLC but pathology with characteristics overlapping with upper GI origin, what additional diagnostic procedures would you consider before treating?
In the absence of imaging findings in a patient with a risk profile consistent with early-stage NSCLC, I would probably just move forward with definitive management as NSCLC with either surgical resection or SBRT as appropriate. The only other thing I would consider is to make sure they are up to da...
Would you offer a bone marrow biopsy to the patient with normal CBC and low MDS-associated mutation burden found on NGS?
Generally speaking, we don't perform NGS sequencing for MDS-associated somatic mutations in individuals with normal blood counts. However, the issue does arise when cancer patients undergo blood-based sequencing for other reasons, for example. And, in the future, we may see more mutation testing in ...
How do you schedule IV/PO Dexamethasone if giving immunotherapy concurrently with chemotherapy in patients with NSCLC?
We follow the methods listed in the clinical trial publications. For instance, KEYNOTE-189 followed standard steroid pre-medications for pemetrexed, and KEYNOTE-407 did the same for paclitaxel. Since the monoclonal antibodies tend to have long half lives and steroid premeds are given for such a shor...
With the current cisplatin and carboplatin shortages, for HPV+ H&N patients with indications for concurrent chemoRT, which agent do you recommend next?
The question of 2nd line therapy is difficult due to the dearth of data. This leaves essentially 3 choices - immunotherapy, cetuximab, or other cytotoxic agents.Regarding immunotherapy, recent trials for concurrent IO have been mixed, tending to compare IO vs Cetux. The main take-home though, is the...
How do you dose FOLFOX when given with concurrent chemoradiation in esophageal adenocarcinoma?
I don’t use FOLFOX within this setting.
How do you approach patients with polypoid/nodular melanoma for adjuvant therapy when Breslow depth is not available on pathology?
If it is nodular, the depth of invasion (Breslow) starts from the outer edge of the lesion vertically down and perpendicular to the dermis, so most likely if polypoid, it will be at least 3 or 4 mm, thus T3 or T4. If ulcerated, T3b or T4b.
Can you use NGS panels or ctDNA to help you find organ of origin in the workup of carcinoma of unknown origin?
At least 2 NGS panels available in the US now offer tumor of origin (TO) profiling. Both Tempus and Caris offer such testing. There are other panels out there using different methods such as epigenetic profiling and WGS. How much this testing improves diagnosis and outcomes is not clear and 2 trials...
What systemic treatment do you utilize for patients with metastatic fibrosarcomatous DFSP that have progressed on imatinib?
Unfortunately, these fibrosarcomas do not respond well to other TKIs. Modest activity of standard STS chemotherapy.
What post-auto maintenance therapy do you recommend for patients with high-risk multiple myeloma?
This is tough. You want each particular risk group to correspond to a maintenance treatment that is likely to benefit the patient - not too much nor too little. The definition of high risk has changed from one single characteristic or one cytogenetic abnormality to a more additive model such as the ...