Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Do you resume immunotherapy (such as nivolumab) for metastatic melanoma after therapy-induced grade 4 hyperglycemia that has resolved?
The answer is probably yes depending on the circumstances. If on a trial then no. If SOC then could consider it and since the patient probably has the equivalent of type 1 diabetes requiring insulin supplementation then unlikely to hurt them more. If the pancreas recovered then it would be a risk be...
For ALK+ patients rendered NED from oligometastatic NSCLC after resection of both lung primary and isolated CNS lesion, do you consider offering treatment with an ALK inhibitor after adjuvant chemotherapy, or do you place into surveillance?
A large proportion of patients with oligometastatic disease managed with curative intent generally relapse, either intracranially and/or extracranially. TKI therapy maybe expected to prolong disease-free/progression-free survival based on our experience with EGFR TKIs. However, given the expected du...
How would you approach a chronic phase CML patient who is responding to second generation TKI but not yet in molecular remission and is now pregnant?
If the patient is now pregnant, I would stop the TKI immediately, and initiate therapy with interferon. If that is not tolerable, I'd recommend hydroxyurea, although it will likely not control relapse into overt chronic phase.
How do you manage a patient with a history of non-seminomatous germ cell tumor who has a rising AFP after primary chemotherapy without any imaging evidence of recurrence?
It would depend on the timing of the rise of AFP after chemotherapy, how elevated it is, whether they were good or poor risk patients at the time of chemotherapy, whether they had liver disease and whether the AFP was definitively elevated prior to chemo In most cases, we sort of ignore AFP < 25 or ...
For male patients in chronic phase CML on a TKI and not yet in a MMR, is there a preferred amount of time spent in a MMR before discontinuing TKI therapy to conceive or bank sperm ?
Hard to answer this one. My preference would be that the patient be in MMR confirmed by two readings three months apart before experiencing a dose interruption.
Would you ever omit adjuvant therapy for rectal cancer in patients who underwent primary resection (TME), without any neoadjuvant therapy?
What is your approach to the upfront treatment of anaplastic large cell lymphoma, ALK positive, with low IPI score in a young person?
ALK positive ALCL is the most responsive of the aggressive PTCL’s to chemotherapy, and the majority of young patients can be cured with an anthracycline containing chemotherapy regimen. Either CHOP or CHOEP (ie CHOP plus etoposide) are frequently used. In a young healthy patient I favor CHOEP based ...
Would you use ado-trastuzumab as first line therapy for metastatic Her2+ breast cancer in a post-menopausal woman who developed metastatic disease years after finishing dual Her2 directed therapy?
The FDA label provides for upfront useage of TDM1 if the patient develops metastatic recurrence within 6 months of adjuvant therapy. In this case since it has been years i would try dual blockade with TPH again as the patient may respond again.
Do you rely on Ki67 as an estimate of proliferation to guide the decision for chemotherapy in premenopausal women with hormonally-driven breast tumors?
Far from it. Especially in premenopausal women, Ki-67 is affected by circulating hormones and time of the month, and it is not a reliable indicator of endocrine resistance. In postmenopausal women, the most valuable Ki-67 reading is on endocrine therapy if any, not baseline either. Ki-67 should not ...
Do you recommend adjuvant or indefinite systemic therapy after surgery/radiation for patients with synchronous bilateral breast cancers that are of the same histology and receptor status?
Synchronous bilateral breast cancer is rare and often presents with concordant histology, but is generally considered 2 primaries rather than metastatic disease due, possibly, to common exposures of similar clones. Despite controversy and conflicting reports, long term survival has been reported. It...