Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How do you manage a young patient with mediastinal nonseminomatous germ cell tumor that has relapsed after primary treatment with four cycles of VIP?
Patients with primary mediastinal nonseminomatous germ cell tumors (PMNSGCT) are at poor risk regardless of the size of the tumor or amplitude of AFP. Unfortunately, second-line therapy does very poorly. There would be zero curative value for TIP or VeIP after prior VIP, of course. Despite respectab...
How do you manage MEK inhibitor induced ocular adverse events?
MEK inhibitor associated ocular adverse events may range from subretinal fluid, which does not typically require medication cessation to uveitis, which is treated according to the level of inflammation. In one report of optical coherence tomography scan evaluations to image retinal structures follow...
When, if ever, would you consider using encorafenib/binimetinib or vemurafenib/cobimetinib instead of dabrafenib/trametinib for adjuvant treatment of BRAF mutated melanoma?
Do you have a preferred therapy for patients with metastatic gastroenteropancreatic (GEP) neuroendocrine tumors that progressed through octreotide and PRRT?
As we gain more experience with PRRT, this is a more and more common scenario in the clinic. I am going to restrict this discussion to grade 1/2 GEP-NETs. There are a few things I consider when a patient progresses on PRRT. The first is the duration of response they achieved on the initial 4 doses o...
Would you consider using checkpoint inhibitor therapy as an alternative to adjuvant mFOLFIRINOX in a patient with a very high risk resected pancreatic adenocarcinoma (poorly differentiated, N2 disease) and Lynch syndrome?
My inclination would be to offer standard of care modified adjuvant folfirinox and reserve pembro for documented recurrence. However, one could not criticize the use of pembro as adjuvant even with lack of proof in this setting. Also, if initiated, how long would you treat?
Are docetaxel and paclitaxel interchangeable for stage II-III HER2+ breast cancer patients receiving neoadjuvant chemotherapy with AC-THP?
I believe docetaxel and paclitaxel are interchangeable in AC-THP for neoadjuvant chemotherapy for HER2 positive early-stage breast cancer. Decent phase II data from MSKCC confirm that the paclitaxel combination is well tolerated with PFS similar to CLEOPATRA.(Dang et al., PMID 25547504).The larger q...
What is the optimal neoadjuvant systemic therapy dosing and schedule in a patient with undifferentiated pleomorphic sarcoma of the extremity for whom up-front surgery would portend significant morbidity?
Assuming the patient has no major co-morbidities, has normal PS and organ function, we would give AI (75/10) q 3 weeks, with q 2 cycles re-imaging, for up to 6 cycles based on response/tolerance. This would then be followed by pre-op XRT and then WLE, assuming it has become feasible.
Would you offer chemotherapy to a postmenopausal woman with microinvasive ER/PR positive, Her2 negative invasive ductal carcinoma with a single lymph node metastasis and insufficient tissue for Oncotype testing?
I would want to obtain information about how strongly ER and/or PR positive the cancer was on IHC, and also the size of the lymph node metastasis. The other information that would play a role for me here would be the patient's age, Ki67 (if available), tumor grade, and any other comorbidities. Since...
Do you re-test patients who test positive for COVID-19 during or prior to starting cancer treatment?
Here is a summary from the CDC website supporting a 'symptom-based' approach with self-quarantine for ~10-14 days after symptoms (perhaps 21 if severely immunocompromised or severe COVID symptoms) without need for a negative test. From: https://www.cdc.gov/coronavirus/2019-ncov/hcp/duration-isolati...
Would you consider HRT after BSO in a pre-menopausal gBRCA2+ patient who has no intention of ever having prophylactic bilateral mastectomies and who declines chemoprophylaxis?
Yes, I would consider HRT in this patient with several caveats and realizing that there are no data specifically applicable to this situation. Still, one can make inferences from the existing literature. There are well-documented long-term effects and lower survivals in younger women who have had an...