Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
What is your approach to gynecologic examinations/surveillance in a standard risk patient on adjuvant tamoxifen?
In the absence of symptoms (abnormal bleeding or discharge, pain, etc.), I do not recommend gynecologic examinations/surveillance beyond what is appropriate given the woman's age. First, premenopausal women on tamoxifen are not at increased risk of developing endometrial cancer. In postmenopausal wo...
How would you approach a patient with BRAF V600E mutated dMMR stage II colon cancer?
One could consider checking circulating tumor DNA. This is an evolving technology in colon cancer that might sway you to offering adjuvant chemotherapy if this test suggested a high risk of recurrence.
What is you approach for first line treatment in an elderly patient >85 years of age with good PS and a hairy cell leukemia variant?
The 1st question is: does he need treatment? Such as significant cytopenia(s), symptomatic splenomegaly, or constitutional symptoms? If so, and at > 85 yo, I will probably try rituximab alone after discussing with him that this is typically reserved for a relapsed disease, but the alternative is che...
Would you include carboplatin with an anthracycline and taxane for neoadjuvant treatment for triple negative inflammatory breast cancer?
It's important to talk about such an option that exists if the patient is young and does not have major comorbidities. But, adding the carboplatin for the TN-IBC is not absolutely required. The IBC experts have had multiple discussions about this issue.There are some data in the non-IBC setting abou...
Would you use a myeloablative or reduced intensity conditioning regiment for a pediatric or AYA patient who does not recover their counts after treatment for AML, but remains disease free?
I would use a myeloablative regimen, if medically fit and eligible. In fact, I would worry that there is a residual disease (that you're unable to detect) behind the lack of CBC recovery which is another reason to use a myeloablative regimen.
Would you consider treatment with sacituzumab in triple negative metastatic breast cancer if there has been progression on irinotecan?
While I am not aware of any data on the efficacy of sacituzumab govitecan (SG) in such patients, not surprising since irinotecan is not commonly administered to such patients, I would not rule out a trial of this agent. We know that ado-trastuzumab emtansine can be effective in patients progressing ...
Would you consider adjuvant nivolumab to be the standard of care in stage II/III esophageal/GE junction cancer after completion of neoadjuvant chemoradiotherapy and surgery?
Patients with gastric or GEJ adenocarcinoma who achieve a pCR following preoperative therapy still have a significant risk of recurrence and cancer-specific death following resection. Although recurrence at 5 years can be significantly lower for pCR vs non-pCR patients (27% and 51%), the probability...
Would you treat a patient with refractory, metastatic castrate resistant prostate cancer who has somatic ATM mutation with a PARP inhibitor?
Yes, I would consider Olaparib (not Rucaparib), but only after they have received at least two AR-targeting drugs and at least one taxane drug, and only if an ATR inhibitor trial was not available. And I would set the expectations really low: PSA response rate of 5-10%, PFS of 4-6 months.
How do you approach treatment in a patient with a solitary plasmacytoma with minimal marrow involvement (< 10% clonal plasma cells)?
Solitary plasmacytoma with minimal bone marrow involvement is a confusing entity as even the name seems somewhat contradictory--it is indicating there is a solitary lesion but at the same time indicating that there is systemic involvement (i.e., bone marrow involvement by clonal plasma cells). It is...
What is your approach to patients who experience widespread progression on EGFR inhibitors found to have MET amplification on tumor biopsy in addition to sensitizing EGFR mutation?
Ideally, speaking they should be enrolled in clinical trials with a bispecific antibody for EGFR and CMET or drugs targeting CMET with continued EGFRi. There is a paucity of data on continuing Osimertinib on progression with Crizotinib or Capamatinib. In clinical practice, chemo or chemoIO is also a...