Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
What is your approach to the use of denosumab in patients with metastatic breast cancer with bony involvement?
I do not extrapolate the results of OPTIMIZE-2 and CALGB 70604 to denosumab. It is a different drug and until appropriate studies are performed, there is no reason to change its dose or schedule.
How would you treat a Stage II gastric adenocarcinoma with de-differentiation to high grade neuroendocrine tumor post resection?
This is a challenging scenario... what to do with a mixed-phenotypic tumor such as this, which is actually not all that uncommon and we all face from time to time? For a pure gastric adenocarcinoma s/p resection (stage II/III), I favor a Capox/FOLFOX-type regimen, a la the Korean phase III CLASSIC t...
Would you consider a trial of anti-PD-1 therapy following disease progression through anti-PD-L1 therapy for advanced urothelial carcinoma?
This is a great question and should be answered in a clinical trial setting. We need trials in patients with progression on anti-PDL1 or anti-PD1 agent; currently we don't have data to answer this question of cross-resistance
What is the optimal regimen for advanced stage Nodular Lymphocyte Predominant Hodgkin Lymphoma?
I do not believe that there is an "optimal" chemotherapy regimen for advanced nodular lymphocytic predominant Hodgkin lypmhoma. The most commonly used regimen is probably ABVD +/- rituximab. CHOP-R might be a good choice when the question of early transformation to diffuse large B-cell lymphoma is s...
Are there contraindications to giving radium-223 concurrently with palliative radiotherapy or systemic chemotherapy for mCRPC?
These combinations have not been approved, but studies of radium-223 with taxane therapy have been conducted in concert with docetaxel and have been presented in 2017 at GU ASCO by Michael Morris. These studies show that the combination is promising but myelosuppresive. The response rates to combine...
What is the preferred regimen for testicular lymphoma with de novo symptomatic CNS involvement and systemic disease at the time of presentation ?
I often consider treating with high dose methotrexate alternating with R-CHOP in such cases. At the end of treatment, I consider radiation to the contralateral testicle. Others have treated similar patients with Hyper-CVAD (Park et al. Am J Hematology 2007)
Is there an effective treatment for multiple appearances of cutaneous Kaposi's lesions besides radiation?
Unfortunately, there is no established effective treatment for multiple appearances of cutaneous Kaposi's lesions. Radiation therapy seems to work if the dose is adjusted well. Radiologists are very familiar with this. However, there are often out-of field recurrences which are difficult to treat. ...
What surveillance strategy do you use for patients after resection of localized renal cell cancer?
Surveillance depends on the pathological stage of the patient. For T1a disease I follow annually. For T1b disease and higher I follow q 6 mos with MRI imaging if abdimen and low dose Ct of chest. I do not perform imaging of bones or brain without a clinical indication. For LN positive disease i star...
For untreated patients with minimal complaints and good PS with metastatic adenocarcinoma positive for Exon 21 L858R mutation, how do you choose among the available first line EGFR directed therapies?
Based on the secondary analyses of Lux-Lung 3 and Lux-Lung 6, which showed a survival advantage for afatinib vs platinum-based chemo in patients with exon 19 deletions, I've generally turned to afatinib in this group, while reserving erlotinib for those with exon 21 mutaitons. Lux-Lung 7 has had onl...
How do you manage adjuvant therapy for patients with locally advanced ER positive breast cancer with no response to neoadjuvant endocrine therapy?
For patients with ER+ locally advanced disease and no response to neoadjuvant chemotherapy (assuming an optimal chemo regimen was given -anthracycline and taxane based, my preferred regimen in this setting would be AC dose dense X4 with pegfligrastim followed by paclitaxel weekly X12) , then the tum...