Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
For a patient with inflammatory breast cancer after standard initial systemic therapy with only a partial response, do you recommend more systemic therapy, pre-operative radiation, or proceed to modified radical mastectomy?
If the disease is operable with a partial response, then we proceed with surgery. Otherwise, we try a different chemo regimen and sometimes preoperative RT to make it operable.
Should FISH studies be repeated when CLL patients under active surveillance have progressive disease warranting treatment?
FISH studies should be performed on a newly diagnosed patient with CLL as well as those who have progressive disease and now warrant additional therapy. It is important to identify those patients who may have acquired additional cytogenetic abnormalities due to clonal evolution/resistance/etc as thi...
When should intermittent androgen deprivation vs continuous androgen deprivation be used for the treatment of prostate cancer?
I think the question posed and the patient example are really 2 different questions. To address the title question, let me call your attention to a recent article in the JCO 34: 280-5, 2016, and an accompanying editorial, which review this issue in detail. The authors point out that there are signif...
Would you consider SBRT for an inoperable T1-T2 N0 SCLC?
The concept of using SBRT in the setting of inoperable early-stage node negative small cell lung cancer (SCLC) is interesting and replicates the concept of SBRT as a surgical surrogate. In other words, SBRT is used to manage the primary lesion, as with early-stage non-small cell lung cancer (NSCLC)....
Is there a role for adjuvant docetaxel in patients with high-risk localized prostate cancer who elect for prostatectomy?
Currently, there is no data to support the use of adjuvant docetaxel following radical prostatectomy. Given that these are two entirely different treatments in different patient populations, there is no rationale for extrapolating the results from RTOG0521 to a post-surgical (even if high-risk) popu...
How would you follow patients with differentiated thyroid cancer that no longer picks up iodine after thyroidectomy and RAI, and have thyroglobulin antibodies?
The presence of antibodies makes measuring the thyroglobulin level essentailly inaccurate. PET imaging may have a role though clear data on its utlity is limited (and it's expensive). Physical exams and Ultrasonography is the best way of monitoring the disease state from a surveillance point. For sy...
Following presentation of the PRINCE at ASCO 2016, should we be offering intermittent docetaxel to patients with metastatic castration-resistant prostate cancer?
The simple answer is no, as this study was dramatically underpowered to reach any conclusion. A couple of issues:1. This trial was designed after the TAX 327 data showed q3 week therapy to be the standard of care. This trial allowed weekly therapy anyway, likely because some of their docs wanted to ...
Is there a role for VeriStrat testing in determining when to use an EGFR TKI in previously treated squamous cell NSCLC?
Excellent question and one that we have very little data to answer. Extrapolating from the second line PROSE trial (http://www.ncbi.nlm.nih.gov/pubmed/24831979), it seems reasonable to consider this test to help choose between TKI vs. chemotherapy as a third line option. That said, there are certain...
Should local consolidative therapy be offered to patients with oligometastatic NSCLC who do not progress after induction systemic therapy?
We were one of the three sites that accrued patients to this trial, and the benefits are compelling (a tripling of PFS, along with an OS benefit). Randomized phase II trials are usually not meant to be definitive, but these results are very informative for clinical practice. It's also important to n...
How should RT be combined with immunotherapy to generate an abscopal response?
This is a difficult question to answer because cancer "immunotherapy" is really a variety of heterogeneous therapeutic approaches. Nevertheless, I am aware of no consensus that specifies the optimal radiotherapy dose, fractionation, timing, or target, when used in conjunction with any specific form ...