Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How would you approach adjuvant treatment of an early stage HR+ HER2+ cancer if the patient had already been taking an aromatase inhibitor for a contra-lateral HR+ early stage breast cancer?
My preference would be to recommend local and systemic treatment based on the newly diagnosed breast cancer, including its final pathologic staging and other clinically relevant features. If chemotherapy is needed, I would hold endocrine therapy. When the time comes to resume endocrine therapy, my p...
Would you consider using a PARP inhibitor as maintenance therapy after initial platinum chemotherapy in a patient with metastatic pancreatic cancer who has a somatic non-BRCA DNA damage repair gene alteration?
This is an important question regarding the use of a PARPi as maintenance therapy in HRD genes beyond BRCA1/2, including, PALB2, FANC, CHEK, ATM, NBN, RAD51, MRE11, BARD, etc. As of now, there are limited data to confirm value, however, this is the subject of several ongoing trials evaluating the ro...
Is there benefit in switching between sonedegib to vismodegib or vice versa for patients with unresectable basal cell carcinoma of the face that progresses on first line hedgehog inhibitor?
Immunotherapy has largely supplanted hedgehog inhibitors for most BCC patients given the toxicity of hedgehog inhibitors and the reliable recurrences seen after initial responses. If I want short term palliative care, I think hedgehog. If I want a real chance at a cure, I think immunotherapy.
How would you treat triple negative breast cancer involving a pericardial effusion?
If the patient has no tamponade at presentation I usually started standard systemic therapy with close monitoring by cardiology/CT surgery to do a pericardiocentesis followed by a pericardial window (percutaneous if possible) in the event hemodynamic changes occur. I have not done intrapericardial t...
Do you routinely offer chemotherapy after resection of solitary or oligometastatic pulmonary nodule/s in young patients with previously treated soft tissue sarcoma who are otherwise without any evidence of disease?
No. If there is a good reason to use systemic therapy, better timing is to use it before metastasectomy with measurable/evaluable disease to avoid unnecessary prolonged exposure in the stage 4 NED scenario.
Would you introduce AR targeted therapy if a patient has already been successfully treated with LHRH for low risk, low volume metastatic hormone sensitive prostate cancer?
Most trials of novel AR targeted therapies, started the novel AR blockers within 3 to 6 months of starting standard androgen deprivation therapy. Hence, if that period has passed and the patient is doing well on standard Androgen deprivation therapy, I do not see a need to introduce a novel AR inhib...
What is your approach in deciding on definitive therapy for locally advanced, HPV-negative head and neck cancer unsuitable for standard cisplatin based chemo?
The real answer is it depends on the medical oncologist as (s)he typically administers the therapy.It also depends on why cisplatin is contraindicated. Is it an otherwise healthy patient who has renal or hearing issues, or is it an elderly patient with a marginal PS for whom cytotoxics, in general, ...
What adjuvant treatment would you recommend for a Stage I HER2 positive breast cancer with grade 3 neuropathy from previous taxane treatment?
The ATEMPT trial showed adjuvant TDM1 was associated with lower rates of significant neuropathy vs TH (11% vs 23%). Also, CMF (4-6 cycles) plus trastuzumab-based off of Tryfonidis et al., PMID 28324265 safety data is another option for early-stage HER2+ breast cancer in patients with significant pre...
How would you treat oligometastatic NSCLC (brain and bone) with Non-V600E BRAF mutations?
I would treat with chemo-pembro. Down the road, MEK inhibitors is a choice.
How would you approach metastatic NSCLC (adenocarcinoma without brain mets) with PD-L1 >50% and BRAF V600E driver mutation?
I would start with dabrafenib + trametinib based on what we know from available relevant trials and the literature. -- Response rate for dabrafenib + trametinib as 1st-line therapy for people with BRAF V600E NSCLC was 64%. -- Response rate for pembrolizumab as 1st-line therapy for people with NSCLC ...