Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Is tumor deposit (N1c) alone an indication for adjuvant chemoRT for rectal cancer that did not receive neoadjuvant therapy?
Some patients such as this were undoubtedly included in the early rectal cancer trials [GITSG and Mayo North Central (NCCTG)] that established the role of post-operative chemoradiation for stage II and III rectal cancer. However, accrual numbers were too small for stratification of TN subsets and it...
How do you manage ALK-inhibitor AEs which are low grade but significantly impact patient QOL over time?
How to manage ALK directed therapy adverse events that are low-grade but significantly impair quality of life remains a challenge. Some of these adverse events include fatigue, nausea, rash, and loss of appetite. More often than not, these side effects are not pronounced but over time can impair qua...
How do you approach a patient with discordant mutation testing in liquid vs tissue biopsy for mNSCLC?
The recent advent of liquid biopsy testing for patients with advanced non-small cell lung cancer has generated a tremendous amount of enthusiasm and has altered the diagnostic algorithm for patients. We now have data that shows that liquid biopsies are reliable, are accurate, and can inform treatmen...
What treatment would you offer for a patient with unresectable triple negative breast CA who remains unresectable after completion of dd AC-T?
If the patient was responding to treatment but maybe presented with a large mass and had an insufficient response to chemo to convert her to resectability, further chemotherapy with carboplatin, preferably in combination with another agent - and I wouldn't rule out using docetaxel, given the activit...
For a patient with distal esophageal adenocarcinoma with residual disease after FOLFOX x3 cycles + RT followed by surgery, would you recommend adjuvant chemotherapy or adjuvant nivolumab?
CM577 has simultaneously done 2 things: established nivolumab as a standard-of-care in this setting but also hopefully discourages/eliminates the use of adjuvant chemotherapy. There are absolutely no data to justify giving more or different chemotherapy to such patients. Remember, the control arm of...
What is your preferred first line systemic therapy for metastatic chordoma?
Should high-dose methotrexate be used in the treatment of AYA patients with osteosarcoma?
It has been our practice to use high dose methotrexate (HDMTX) in the treatment of our AYA osteosarcoma patients. Methotrexate has been an important component of most osteosarcoma treatment protocols for many years and is generally considered part of the standard of care for this disease (Grem et al...
After an optimal tertiary cytoreduction for recurrent granulosa cell tumor previously treated with BEP and hormonal therapy, would you recommend systemic chemotherapy?
Yes, I would give adjuvant therapy. I would go with carbo taxol. The MD Anderson people have been using this regimen for some time. It is less toxic and appears to be as active as BEP. I think Jubilee Brown published a paper on this subject recently. This exact meeting was not specifically addressed...
Do you avoid immunotherapy in patients with Stage IV NSCLC with atypical EGFR mutations such as G719S or S768I?
This is a difficult situation, but typically I would try to treat patients with an EGFR TKI (ideally in the context of a clinical trial) or with afatinib. Pooled data from the LUX-Lung studies [Yang et al., PMID 26051236] demonstrated an ORR of 71%, PFS 10.7 months, and OS of 19.4 months for Group 1...
Would you avoid capecitabine in favor of fluorouracil in the adjuvant treatment of colon cancer for a patient with history of a gastric bypass?
Yes, that would be a good reason to use adjuvant infusional 5FU over capecitabine due to concerns about absorption. In general, 6 mo of FOLFOX would be used in lieu of 3-6 months of adjuvant cape/ox. Here is a reasonable resource for this decision, showing faster absorption of capecitabine in gastre...