Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
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
Would you offer additional systemic treatment to a stage II or III resected colon cancer that received 3 months of adjuvant capecitabine/oxaliplatin and now is presenting with a solitary lung metastasis?
Thanks for the question!First, it is important to clarify whether this lesion developed during or right after adjuvant CAPEOX, if so, there is no point in continuing adjuvant CAPEOX (it is very important to compare with baseline restaging scans performed before starting adjuvant therapy, as solitary...
Would concurrent CRLF2/IgH rearrangement affect your treatment recommendations for an adult patient with Ph+ p190 high risk (Age>35, WBC >30) B-cell ALL that was started on induction therapy with ponatinib + blinatumomab?
Short answer: No. Longer answer: We lack a clear understanding of how to change treatment for adults with CRLF2 fusions with Ph- ALL, and this is the situation where it is more clearly understood to have prognostic significance (Roberts et al., PMID 27870571). In my view, it would be very difficult ...
For a patient who has T4 squamous cell esophageal carcinoma on imaging, and who has biopsy-confirmed disease in an involved local lymph node, are EUS or EGD still indicated to complete workup?
EGD will help better define the mucosal extent of the disease. EUS would not help much but if upper thoracic, bronchoscopy may help to rule out invasion.
Do you prefer to use 7+3 or CPX-351 as standard induction therapy in younger patients with AML-MRC or t-AML?
I prefer to use 7+3 based on the fact that Lancet et al., PMID 30024784, that showed the benefit of CPX-351 was in adults over 60.A paper by Othman et al., PMID 37171402 showed no overall survival benefit to CPX-351 when compared to FLAG-Ida in younger adults with high-risk AML/MDS.
How would you manage a young patient with HL who develops HF (EF < 30%) after 4 cycles of A+AVD who obtained a PET2 CR?
This is a tough case, and the management would depend on the extent of disease. Assuming that this is advanced stage HL, given the use of BV+AVD, I would be in favor of completing 6 cycles of therapy with a non-anthracycline-based regimen. You can consider consolidative radiation, but this would nee...