Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How would you treat esophageal adenocarcinoma that is locally recurrent after neoadjuvant chemoradiotherapy and Ivor-Lewis esophagectomy?
This is an extremely complicated question, where care has to be individualized in a multidisciplinary setting. Firstly, it's important to ascertain as much as possible that there is no evidence of metastatic disease with a PET/CT scan and contrast CT scan. An endoscopic ultrasound may also help to d...
How do you approach systemic therapy for locoregional recurrence in a patient with triple negative breast cancer who has previously received anthracycline and taxane based chemotherapy?
The CALOR trial took a pragmatic approach and randomized patients to systemic therapy or not. A specific regimen wasn't specified. If the patient has a known BRCA mutation, I would extrapolate from the first line metastatic setting and use a single agent platinum. Outside of that unique situation, t...
When treating patients with immune checkpoint inhibitors, do you routinely check markers of endocrinopathies such as TSH/ACTH, or only when a patient has symptoms?
There are clearly defined parameters for routine monitoring that are outlined in the NCCN guidelines. We have incorporated these into our treatment plans. https://www.nccn.org/professionals/physician_gls/pdf/immunotherapy.pdf
Do you omit adjuvant radiotherapy in T4a laryngeal SCC with favorable prognostic factors?
I guess one could omit PORT for such a situation. I have never encountered this situation and I don't know what data NCCN is using to support this recommendation. Historically, pT4 is the indication for PORT.
How does a finding of low level microsatellite instability (MSI-low) in colorectal cancer change your management?
I currently treat MSI-low the same as MMS, regardless of whether the treatment is in the adjuvant or metastatic setting.
Do you routinely use PET/CT to monitor response to systemic therapies in metastatic breast cancer?
This is an interesting question. I think a lot of us use systemic CT or PET-CT scanning at 3-4 month intervals to screen for progression in MBC while someone is on a therapy. Many of us do this even in bone only disease, looking for new metastases in visceral sites. There is a recent JCO publication...
For a patient with stage III NSCLC who is treated with chemoradiation followed by surgery, when do you offer additional "adjuvant" chemotherapy after surgery?
Several recent trials have addressed management of stage III NSCLC. The intergroup 0139 trial and the EORTC 08941 trial were prospective studies of patients with known mediastinal involvement comparing chemoradiotherapy with or without surgery. Neither prospective trial showed a survival benefit for...
How do you counsel women with a history of breast cancer who have dense breasts, with regards to mammography screening?
The question of how best to follow women after treatment for breast cancer is one that is of great concern to oncologists. Many factors play into the type and frequency of screening. However, little definitive data exists showing benefit of anything above annual screening with mammography. For our s...
Do you offer the addition of necitumumab to first-line chemotherapy for patients with advanced/metastatic squamous cell NSCLC?
There are multiple competing therapeutic strategies for patients with advanced stage squamous cell carcinoma Recent data does demonstrate that the addition of necitumumab to cisplatin/gemcitabine improves survival by six weeks when compared to cisplatin/gemcitabine alone (SQUIRE study). The pros of ...
How do you sequence systemic therapies for recurrent/metastatic head/neck cancer following the recent approval of pembrolizumab?
We currently do not have any available predictive biomarker to inform us on which patients will respond to PD-1 inhibitors based on recently presented data. This work remains investigational. Hence, we do not check PD-1 status to determine whether or not patients should receive immunotherapy.