Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
In women in whom you suspect chemotherapy-induced amenorrhea and are required to start an AI, what is your strategy with regard to ovarian suppression?
For patients who were premenopausal at the time of breast cancer diagnosis (or shortly before) and who cease menses either spontaneously or due to chemotherapy, many will continue to have ovarian production of estrogen without periods, or resume periods for up to 2 years (and sometimes after even lo...
For elderly patients who cannot tolerate chemotherapy, is radiation alone an option for a stage IA favorable classical Hodgkin lymphoma?
In my experience, it has been extremely unusual that a patient with Hodgkin lymphoma is considered a non-candidate for chemotherapy. But I suspect that in community practice that situation may arise because very infirm patients are not referred to major centers and community oncologists may be a bit...
Do you consider local therapy in a patient with de novo metastatic triple negative breast cancer who has a complete response to first line chemotherapy?
I guess the question refers to a complete response in all detectable sites of metastasis and the primary. SHould that be the case, I would consider local therapy of the breast and the metastases if they were few (<3). Otherwise, I do not think the existing data are strong enough to do it.
In patients with good performance status, metastatic clear cell kidney cancer, and minimal metastatic disease, would you consider nephrectomy or partial nephrectomy if there are mets to brain?
Debulking nephrectomy has a clear role in the management of metastatic RCC, based on prospective trials showing an OS benefit. Patient selection, however, is critical for optimal benefit and minimizing risk. Brain metastases often portend a more aggressive systemic disease, and such patients often d...
Should additional molecular testing be performed on triple negative breast cancers up-front to identify potentially targetable mutations (e.g. activating HER2 mutations, homologous recombination repair deficiency assays, etc)?
My institution does not do this routinely. For metastatic triple negative breast cancer, I try to get them on a clinical trial first line and do any trial specific molecular testing that is required if any. But usually somewhere between 1st line and subsequent lines of standard therapy, I send the t...
How do you decide between initial radiotherapy vs systemic therapy in patients with metastatic melanoma and brain metastases?
An interesting question the answer to which is changing!For discussion we will assume that the patient is not previously treated. Presence or absence of CNS symptoms is likely the most important way to dichotomize these patients. Other issues include number and size of the brain metastases, whether ...
Would you consider pembrolizumab treatment in metastatic gastric cancer with absence expression of a single mismatch repair enzyme?
In the modern era, what volume of involvement is considered limited stage SCLC?
The TNM staging system (7th ed.) for lung cancer, which is the standard by which small cell lung cancer should be now staged, includes contralateral hilar and supraclavicular nodal involvement under the N3 rubric, resulting in a global stage IIIB designation. Most oncologists would thus consider the...
How would you treat stage 3 lymphocyte-predominant Hodgkin Lymphoma that is CD20 negative ?
First, I would verify the diagnosis with molecular testing of some sort. It is my opinion that nodular lymphocyte-predominant Hodgkin's lymphoma is universally CD20 positive. The disease is also rarely in stage III. Is it possible that the diagnosis is really another entity such as T-cell-rich B-cel...
Does anaphylactoid reaction to one immunotherapy agent exclude the possibility of using other immunotherapy agents?
Regarding PD1 inhbitors cross reactivity, I have never heard of patients having grade 3+ anaphylaxis with these agents. I have had several patients have infusion related reactions or delayed sensitivities from them. We, however, just re-challenge by slowing infusions rates, administering Benadryl (n...