Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
When would you consider fulvestrant + alpelisib in a postmenopausal patient who has HR+, PIK3CA mutant, metastatic breast cancer instead of initial CDK4/6 inhibitor therapy?
Given that SOLAR-1 study enrolled patients who previously progressed after at least 1 line of endocrine therapy for metastatic disease, I would not offer alpelisib as front line therapy. My preference for front line therapy for metastatic, HR+, PIK3CA mutation-positive breast cancer is a combination...
Do you offer local treatment to the breast primary in patients with de novo oligometastatic hormone positive breast cancer?
The E2108 study by Khan et al., showed that early local therapy in de-novo metastatic BC did not improve PFS/OS, and in fact showed worse OS in the small subset of TNBC in the study (20 patients). Although there was improved locoregional control in the local therapy arm, there was no quality of life...
How would you treat a young patient with symptomatic Rosai-Dorfman disease who has recurrent, life-threatening pericardial and pleural effusions?
Rosai-Dorfman disease is the most tricky one of the top 3 histiocytosis (ECD, LCH, and RDD). It can behave as benign or as an aggressive disease. Given the rarity of the disease, there are no great prospective studies to guide optimal treatments. First-line treatment includes prednisone or other imm...
Do you rebiopsy grade 1-2 follicular lymphoma if SUV is high by PET?
How would you treat a locally recurrent triple negative breast cancer after achieving CR a year earlier to neoadjuvant ddAC-T, BCS and WBRT?
I would recommend staging work up to rule out distant metastases for this patient with high-risk TNBC before committing this patient to local therapy.Isolated Loco-regional recurrences (ILRR) are associated with a high risk of developing distant metastases and early recurrence (< 24 months, as in th...
Are there any preferred chemotherapy regimens for Stage IV NUT carcinoma?
We have a current stage IV NUT carcinoma patient. With permission, I am paraphrasing my discussions with Drs. Christopher French and Dr. Geoffrey Shapiro from Dana Farber Cancer Institute. There is no "standard" first-line chemotherapy regimen. However, in fit patients, the current recommendation a...
How would you approach adjuvant treatment of a locally advanced metaplastic breast cancer with squamous differentiation?
Hopefully, this patient has not yet gone to surgery, although the question suggests this is adjuvant therapy. Metaplastic breast cancer is typically relatively chemoresistant (although I have also had several patients with pCR to standard chemotherapy), with a high risk of hematogenous metastatic sp...
How would you approach the treatment of borderline resectable pancreatic adenocarcinoma in an elderly patient (>80 years old) with a poor performance status who is not a surgical candidate?
First, I would recommend making sure that the patient had a surgical evaluation that included a multidisciplinary team with experience in pancreatic surgeries, if possible, including a discussion of whether other medical conditions can be treated to enable a potential surgery.If after this assessmen...
When do you add chemotherapy to post-operative RT for thymomas after a R2 resection?
Complete resection is the most important prognostic factor in thymomas. Indeed, in multivariate analyses, it may be the only significant prognostic factor (Regnard et al. J Thorac Cardiovasc Surg, 1996). Post-operative radiation is commonly used for R1 and R2 resection. Recent data has questioned it...
Would you proceed to anthracycline based neoadjuvant regimen for locally advanced triple negative breast cancer without clinical response to neoadjuvant paclitaxel or proceed to surgery?
While a lack of response to paclitaxel (don't you now wish that you had added carboplatin?) is concerning and could indicate that the patient has a type of TNBC that responds poorly to chemotherapy, such as AR+, the patient may respond to a different chemo regimen and thus you should proceed to trea...