Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Would you offer neoadjuvant chemotherapy to a patient with muscle-invasive enteric adenocarcinoma of the bladder?
How do the results of CheckMate 9LA and subsequent FDA approval of nivo+ipi+chemo impact your first line management of patients with non-small cell lung cancer?
As many have pointed out, the control arm is no longer SOC and this just adds to numerous ‘me too‘ regimens in frontline non driver mutation NSCLC- atezolizumab, nivo/ipi alone to name a few. It will not greatly impact current practice. If this leads to a price war and brings down the cost of drugs,...
How do you treat extensive stage small cell lung cancer in the very elderly (more than 80 yrs)?
I typically do not go by the chronological age of the patient, but rather their performance status and co-morbid conditions. For patients >80 year old with PS 0-1, I would have no hesitation in using standard carboplatin-etoposide-immunotherapy. For patients with marginal PS, I would use the same dr...
How would you approach a patient with metastatic colon cancer and BRCA2 mutation in next generation sequencing?
We detect more mutations as more patients get next generation sequencing during their colorectal cancer treatment. The BRCA mutation is one of them.BRCA mutations are typically associated with breast, ovarian, pancreas, and prostate cancers. The relationship between BRCA mutations and colorectal can...
Would you use tucatinib in a patient with recurrent HER2+ breast cancer with isolated brain metastasis with leptomeningeal disease?
I certainly would, given the CNS activity seen in the HER2CLIMB trial. I would follow the same paradigm and combine it with capecitabine and trastuzumab.
Would you use alpelisib in patients with biopsy proven hormone negative metastatic breast cancer with a PIK3CA alteration?
The rationale for using PIK3CA inhibitors is to overcome endocrine resistance by combining this treatment with endocrine therapy in ER positive breast cancer. There is no particular logic or data to support using single agent PIK3CA inhibitors in mutation carriers to my knowledge, nor would it make ...
How long after discontinuation of TKI (for complete remission) would you feel it is safe for a patient with CML to consider pregnancy?
Tyrosine kinase inhibitors have been demonstrated, in animal models, to be teratogenic when utilized early in pregnancy. In retrospective studies in humans, congenital anomalies similar to what was identified in animal studies have been reported. Since spermatogenesis takes several weeks, some have ...
What's your preferred management for a newly diagnosed chronic phase CML with concurrent thrombocytopenia?
It is unusual for patients with chronic phase CML to have thrombocytopenia as part of their initial diagnosis. I would first make sure the patient has chronic and not advanced phase CML at diagnosis by preforming a bone marrow biopsy. If the patient does have chronic phase CML, the choice of TKI is ...
Under what circumstances you would consider treating stage II colon cancer with adjuvant chemotherapy?
This is a very interesting question especially at present time. We know not every patient with stage II colon cancer will benefit from adjuvant chemotherapy, and the absolute survival benefit is less than 5% for 5FU based adjuvant chemo treatment (but no category 1 evidence). Oxaliplatin-based adjuv...
How do you approach the decision of whether and when to initiate therapy in patients who remain COVID-19 positive >2 weeks after infection but are asymptomatic from the virus?
If the patient is asymptomatic or minimally symptomatic, we have elected to initiate therapy for the patient. We have treated the patient in full PPE at the end of the day with no other patients in the clinic. Efforts should be made to minimize patient contact throughout the clinic. We have the pat...