Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Would you recommend neoadjuvant chemotherapy for a 3.5 cm low-grade UTUC in a cisplatin-eligible patient?
Neoadjuvant chemotherapy (NAC) conceptually makes sense in UTUC. A number of retrospective studies showed improved surgical and oncologic outcomes with NAC in UTUC. A recent phase 2 clinical trial (Coleman et al., PMID 36603175) confirmed this (63% pathologic response, improved PFS and OS) using spl...
In a patient with very high risk prostate cancer opting for prostatectomy, when, if ever, do you recommend neoadjuvant ADT?
I generally do not offer ADT with or without a potent ARSI prior to RP even in high risk disease. While small single arm studies have shown that a few such men can achieve a pathologic CR and that path CR/MRD is associated with better outcomes after RP, for most patients, this approach has no clear ...
How long do you treat with immunotherapy patients with MSI-high T4B initially unresectable colon adenocarcinoma?
Immunotherapy is an established treatment option for dMMR/MSI-H metastatic colorectal cancer (mCRC) but its optimal duration remains to be determined. A fixed duration of 2 years or until progression or toxicity has been adopted based on the KEYNOTE-177 study. More recently, the GERCOR NIPICOL phase...
How would you treat a patient who received 2 cycles of R-CHOP for DLBCL who was subsequently diagnosed with follicular lymphoma?
It looks like the patient has t-FL. More information is needed: what prompted the biopsy after 2 cycles of R-CHOP? Is his disease progressing after 2 cycles of R-CHOP?
Would you offer capecitabine re-challenge for a patient with metastatic breast cancer and a history of coronary vasospasm?
Doing a 5FU/capecitabine rechallenge after vasospasm can be risky and fatalities have been reported. Capecitabine and infusion 5FU are riskier than bolus 5FU due to prolonged exposure of the endothelium to metabolites. In the US, we lack access to safer alternatives like S1. There are some reports o...
How do you manage a recurrence of colon cancer within 3-4 months of completion of adjuvant FOLFOX?
I think the critical point here is NGS panel done quickly and used to judge your next step. For example, your approach would be different for KRAS mutated cancers vs BRAF V600E mutated cancers, etc. Generally, you would choose a non-FOLFOX regimen for relapse this soon after completion. This is a ve...
In which patients do you offer adjuvant bisphosphates in breast cancer treatment?
I would offer adjuvant bisphosphonate in postmenopausal women with moderate to high risk early stage breast cancer and in patients with osteopenia or osteoporosis needing aromatase inhibitor therapy. I would share the data regarding efficacy and side effects with the patients for shared decision-mak...
Do you consider prior use of cisplatin for a previously diagnosed cancer a contraindication for its use as radiosensitizer in a new head & neck cancer?
No. Platinum remains the standard of care as a radiation (RT) sensitizer for locally advanced head and neck cancers whether treatment first-line or in the recurrent setting. To date, there is no data to support an alternative radiation sensitizer even if disease recurs and re-irradiation is consider...
What is your preferred adjuvant chemotherapy regimen for a patient with local recurrence of TNBC two years after completing neoadjuvant ddAC-T who declined prior adjuvant capecitabine?
There is no clear data-driven option for a patient with TNBC local recurrence, although the underpowered CALOR study does support the use of chemotherapy in the local recurrence setting. I would offer this patient a taxane + carbo + pembro for 4-6 cycles if she doesn't have significant neuropathy. T...
How would you treat Stage III unresectable adenocarcinoma of the lung with a BRAF-V600E mutation?
At this time, I do not think there is any role for BRAF directed therapy in patients with stage III unresectable adenocarcinoma. The standard of care remains chemoradiation followed by durvalumab. There is no evidence to support doing anything else. Unlike EGFR, for instance, where the use of consol...