Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
What is the role for maintenance lenalidomide in elderly patients with DLBCL?
The REMARC study was a phase III trial of maintenance with lenalidomide versus placebo in patients aged 60-80 years old who were in a PR or CR after RCHOP for newly diagnosed DLBCL (Thieblemont et al. JCO 35:2471-2481, 2017.). The results of this large study (650pts) with a median follow up of over ...
How would you incorporate ctDNA to follow up a patient status post surgical resection of the primary colon adenocarcinoma and omental deposits after 6 months of FOLFOX?
This is an excellent question. Can ctDNA add to the treatment algorithm for patients with peritoneal carcinomatosis where imaging frequently underestimates extent of disease? We are virtually in a data-free zone, but one study (Baumgartner, Ann Surg Oncol. 2018) showed that for 59 patients (mainly w...
What is your preferred second-line therapy for metastatic follicular dendritic cell sarcoma after progression on anthracycline-based chemotherapy?
Gemcitabine plus a taxane has good reported activity with an RR of 80% - Jain et al., PMID 28382648.
What adjuvant chemotherapy would you offer for completely resected carcinosarcoma of the pancreas?
This is such a rare neoplasm that obviously there is no standard of care. My only suggestion would be to look for an actionable mutation. Any treatment suggestion is just a guess.
Is it safe for a patient to breastfeed during their course of EBRT?
Not aware of any concerns. In our pregnancy-associated breast cancer patients, I encourage women to breastfeed on the side I am not treating as long as med onc has cleared them. We work with pediatricians to ensure that the infant is reaching normal weight/growth milestones, but may need to suppleme...
How would you approach further systemic treatment after definitive local treatment for patients with locally advanced TNBC that had early local progression through neoadjuvant AC-T, adjuvant cape and adjuvant RT?
If the patient is currently NED, I would not administer further systemic therapy, as there is no evidence that additional treatment will improve outcomes. As oncologists, we are sometimes tempted to 'do something' in situations where we expect the prognosis to be poor, but where there is no evidence...
What is the preferred approach for gastric MALT lymphoma with histologic and radiographic partial response after radiation?
I would probably repeat en endoscopy in 8-12 weeks to evaluate for the potential of delayed complete response. If there is still residual disease at the time, I would treat with Rituxan weekly x4.
Do you consider the presence of multifocality to decide whether to offer adjuvant therapy for patients with node-negative, multiple pT1a triple negative breast cancers?
I take into account the number of invasive foci and the span of involvement (assuming the patient's nodes are negative—if node-positive I would treat as a stage II TNBC). This sometimes occurs in the setting of an area of high grade DCIS with multiple small foci of invasion, which can range from a 1...
What would be your choice of adjuvant chemotherapy for a healthy patient with localized triple negative breast cancer who is not a candidate for anthracycline and has severe neuropathy?
I probably would offer adjuvant chemotherapy with CMF. This is a regimen we don't use anymore, but it clearly improves outcome compared to no chemotherapy.CMF as adjuvant chemotherapy in triple negative BCThis case is described as not being a candidate for anthracyclines and with severe neuropathy, ...
How would you treat a patient with HR+,HER2- metastatic breast cancer with a gBRCA mutation who has progressed on endocrine therapy with a new pericardial effusion?
Assuming it is malignant pericardial effusion, and she has had "local therapies" such as pericardial window, if clinically indicated to prevent tamponade, then there two FDA-approved PARP inhibitors, talazoparib (Litton NEJM 2018) and olaparib (Robson NEJM 2017) for this setting. Both trials were of...