Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How would you modify adjuvant therapy for a patient with ER+ HER2+ breast CA with no response to neoadjuvant TCHP and develops pneumonitis on adjuvant TDM-1?
Retest tissue for Her2. No data for cytotoxic chemo but consider ACx4 and adjuvant Traz/pertuz to complete a year and then perhaps Neratinib especially if ER+ive.
Would you start TKI therapy in a patient with new diagnosis of T-ALL without BCR-ABL gene rearrangement on FISH but found to have very low level p190 transcript on RT-PCR?
I would not. I don't necessarily have any evidence to support this, so this is simply an opinion. I have seen this a couple of times in my clinical practice. If there is truly BCR-ABL present in this patient's leukemia, the level of it would have to be extremely low to only be detectable at this rep...
How do you approach missed doses of durvalumab consolidation in patients with Stage III NSCLC?
This is a common topic that comes up in clinic. In a previous question, the discussion centered around when/if to resume durvalumab if treatment was held due to toxicity. Here, I assume missed doses occurred for non-irAE reasons. Personally, I discontinue treatment at the completion of 1 year of the...
What neoadjuvant regimen would use you for a patient over 70 years old with resectable gastric cancer?
How do you approach chemotherapy dosing in extremely obese patients?
Our approach to chemotherapy dosing for overweight and obese patients remains as we recommended in JCO 2012 by Griggs et al., PMID 22473167. Most overweight and obese patients should be dosed with cancer chemotherapy based on their actual body weight/BSA and any dose reductions should be made as you...
How would you sequence therapies for a patient with chemotherapy-naive metastatic castration-resistant prostate cancer who is MSI-H on tissue-based NGS?
Yes, I absolutely would use Pembrolizumab (200 mg IV q3wk, or 400 mg IV q6wk) in a MSI-high patient with mCRPC who has not yet received chemotherapy. However, I would probably postpone this until after the patient has progressed on one novel AR-directed therapy. I think that the "sweet spot" for usi...
When would you recommend adjuvant therapy for a patient with urethral adenocarcinoma after partial urethrectomy?
My first approach in this setting is to have the pathology reviewed by an expert tumor pathologist, and to be sure of the T stage, margins, N/M stage, and whether any tumor markers are heavily expressed. If there is a strongly expressed tumor marker, such as CEA, I will obtain baseline, and interval...
How do you approach adjuvant therapy for a premenopausal patient with a pathologic BRCA1 mutation whose TNBC had a complete response to neoadjuvant chemotherapy except for an ITC in one LN?
This is technically a Stage 0/RCB-I after neoadjuvant chemo when I calculated it. This patient would not qualify for the current clinical trials looking at additional therapy (ECOG capecitabine vs platinum, now closed; the SWOG pembrolizumab vs observation, still accruing). Looking at CREATE-X, the ...
Should targeted therapies such as Brentuximab or Crizotinib be used in the upfront management of anaplastic large cell lymphoma in a pediatric or AYA patient?
Good question. Importantly, I am assuming that the question is for ALK+ patients who have systemic disease because ALK inhibitors have no role in ALK- disease and cutaneous only ALCL is really an entirely different entity.In fact, the question is the primary aim of COG trial ANHL12P1 which uses eith...
How do you approach contraception and pregnancy counseling in women of childbearing age with Desmoid tumors who may be contemplating future pregnancy?
Sporadic desmoid tumors have a propensity (80% of cases) for women of childbearing age and they do seem to come up during and after pregnancy. Here are my thoughts on contraception and pregnancy for women with desmoid tumors.1. Norethindrone pill. This is not specific to people with desmoids. I am a...