Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How would you manage a patient with JAK2-positive PV who is not responding to hydroxyurea or IFN-alpha for cytoreduction?
I would first evaluate for secondary von Willebrand. Continue ruxolitinib, and try to maximize dose. If HGB well controlled and platelets continue to increase, I would check iron, and replace it gently to see if that would help the platelets. If that isn’t possible, or replacing iron doesn't help pl...
Has COVID impacted the way you consider using subcutaneous pertuzumab/trastuzumab in treatment of HER2+ breast cancer?
Only to a small extent since it still requires a visit and infusion center appointment, but could results in less time in the infusion center and reduce the number of individuals in the infusion center at any given time - an important goal of reducing our overall footprint of number of people in our...
Would you use first line combination immunotherapy with chemotherapy in patients with metastatic low ER/PR+ (<10%), HER2 negative breast cancer?
Low positive with 1% to 10% cells staining for ER are particularly clinically challenging, although uncommon (accounting for 2%-3% of ER-positive cancers). The first step is to make sure the IHC testing algorithm relies on accurate, reproducible assays, and clinically validated methods. Up to 20% of...
Would you recommend a right hemicolectomy for a <1 cm low grade appendiceal goblet cell adenocarcinoma found incidentally during appendectomy without high risk features on pathology?
The simple answer is yes. Right hemicolectomy is recommended for appendiceal goblet cell adenocarcinoma (used to be called goblet cell carcinoid) regardless of disease stage or pathologic features as per the current guidelines from North American Neuroendocrine Tumor Society (NANETS) and the Europea...
When would you consider adjuvant chemotherapy for resected, intermediate grade lung neuroendocrine tumors?
Per WHO classifications, these tumors would be called atypical carcinoids in the lung and well differentiated neuroendocrine tumors, grade 2-3 in the GI tract. I'm not sure why the two systems of classification have not been aligned.As an intermediate grade tumor, atypical carcinoids have higher pot...
How are you considering the cost impact of subcutaneous pertuzumab/trastuzumab in your treatment planning?
Yes, this is an important institutional and patient consideration, although this is mostly in the hands of our Pharmacy Departments and administrative personnel who have the best financial information
Would you feel comfortable changing to subcutaneous pertuzumab/trastuzumab in a patient who has already been receiving IV formulation?
Yes, I have been switching people over from IV therapy to SQ over the past few months, and patients have liked it. Conversely, most patients who start SQ HP don't want to switch to IV therapy.
What non-taxane chemotherapy, if any, would you give with trastuzumab in adjuvant setting of a pT1cN0 HER2+ breast CA in patients with hyperbilirubinemia >3 due to cirrhosis?
In this difficult case, the risks of any therapy may outweigh the benefits. Depending on the patient's age, etiology of the cirrhosis, and eligibility for liver transplant, I might think about single-agent trastuzumab.
Are there conditions where you would specifically favor using the subcutaneous over the IV formulation of pertuzumab/trastuzumab?
Specific conditions I favor nclude, but not limited to the following: 1. Patient is receiving a non-IV containing regimen 2. Patient has limited peripheral access or no central access 3. Patient has a current central access that poses an infection risk or otherwise has an indication to be removed...
Would you offer adjuvant chemotherapy for patient with a large, high-grade leiomyosarcoma of the colon who underwent an R0 resection with no lymph node involvement?
One needs to ensure that GIST has been ruled out and this represents the very rare, true LMS of the GI tract. These do tend to behave aggressively, but data on the efficacy of standard systemic therapy in this specific subset is very limited. Given that, the standard of care has to be close observat...