Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Is it safe to offer breast/chest wall radiotherapy while a patient is receiving Perjeta?
The question of concurrent pertuzumab and radiation in the palliative setting will likely come up more often now with the recent striking improvement in overall survival of 15.7 months in stage IV HER2+ patients treated with docetaxel pertuzumab and trastuzumab as compared with docetaxel and hercept...
Should early referral to palliative care be standard of care for all patients with metastatic cancer?
There are data to support that early palliative care involvement can improve patient quality of life. One study that specifically comes to mind is a study published by Temel et al in NEJM 2010 (http://www.ncbi.nlm.nih.gov/pubmed/20818875) in the setting of metastatic NSCLC. This study randomized pat...
What is the role of radiation consolidation after chemotherapy for residual splenic involvement in follicular lymphoma?
Recommend 3000 cGy in 15 fractions
Is there a role for anti PD-1/checkpoint inhibitors or other immunotherapies with radiation?
There's a lot of enthusiasm, and fairly little evidence so far. Driving the interest is the observation made over the past several decades, that radiation can induce an immunologic/abscopal response: that by treating one site of disease, a systemic response is initiated that results in responses in ...
In which patients with early-stage favorable Hodgkin's lymphoma, if any, would you consider omitting consolidation RT after ABVD chemotherapy?
The GHSG HD16 randomized trial was recently reported at ASH (Abstract 925). Patients with early-stage, favorable HL (per GHSG criteria) were randomized to standard treatment (ABVD X 2 followed by 20 Gy of RT) or a PET-directed approach. If PET negative after 2 cycles (defined as Deauville 1-2), then...
Do you recommend breast MRI for patients with invasive lobular breast cancer considering breast conservation therapy?
I agree with @Dr. First Last. I used to get MRIs in women with lobular cancers routinely, but as data have shown no outcome benefit to pre-op MRI and a higher mastectomy rate associated with the use of MRI, I now only get MRIs in patients in whom the surgeon feels that the other imaging is too equiv...
In Stage I-II primary mediastinal B-cell lymphoma (PMBL), bulky or non-bulky, is post-chemotherapy radiotherapy still standard in patients with a complete response to CHOP-R chemotherapy?
Primary mediastinal B-cell lymphoma (PMBCL) is a rare subtype of DLBCL. It is a clinicopathologic entity by WHO criteria (which makes it occasionally difficult to conclusively diagnose). The typical patient is young, female, with a large, anterior mediastinal mass. The optimal therapy for PMBCL is c...
Should all GISTs be sequenced?
I believe that any GIST that is going to be treated with a TKI should be sequenced. The mutational response to TKIs are now well documented. 10% of GISTs are wild type and do not respond to Gleevec or Sutent. In addition, certain mutations like D842V in PDGF are also not druggable.
In what situations would you consider starting zoledronic acid in an adjuvant setting for a woman with T2N0 hormone positive breast cancer?
Adjuvant bisphosphonates should be considered in older, postmenopausal women or in younger, premenopausal women who are on ovarian suppression. I would check a baseline DEXA scan in this particular woman, and if she has osteopenia or osteoporosis, I would start her on a bisphosphonate. She would be ...
Do you ever offer neoadjuvant endocrine therapy to pre-menopausal women?
I do not tend to offer neoadjuvant endocrine therapy to premenopausal women, unless it is in a clinical trial setting. There is limited data available but 6 months of ovarian suppression plus an aromatase inhibitor was found to be more effective in reducing tumor size than tamoxifen (clinical partia...