Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Do you use off label olaparib in metastatic HER2 negative, BRCA2 positive breast cancer based on the OlympiAD data presented at ASCO?
Both olaparib and talazoparib have presented phase III trials in patients with advanced breast cancer and mutations in BRCA1 or 2 demonstrating more than doubling of response rates and significant improvement in progression free survival with an associated improvement in QOL compared to treatment of...
In which Her2+ breast cancer patients would you recommend extended adjuvant therapy with neratinib?
The benefit is largely in estrogen receptor positive patients and the gains are modest. Although with extensive and extended anti-diarrheal medications the almost intractable diarrhea seen with this agent can be made tolerable. On the other hand, it would take a VERY motivated patient, probably with...
Would you consider local therapy (e.g. XRT) in patients with mRCC with oligometastatic disease progression?
This is a good question. The role of local therapy in mRCC should (in my opinion) be limited to 2 settings. a) A patient with mRCC who is experiencing pain from a metastatic site. b) A patient with an indolent disease course and overall low volume of metastatic disease in whom local therapy such as...
How do you approach treatment for metastatic cutaneous squamous cell carcinoma after standard chemotherapy failure?
Immunotherapy seems to be active in cutaneous squamous cell carcinoma and I think checkpoint inhibitors are a good option for patients who have failed cytotoxic chemotherapy or cannot receive chemo. In an expansion cohort of a phase I study of REGN2810, a PD-1 inhibitor, the response rate in 26 pati...
Would you consider exemestane (instead of fulvestrant) in post-menopausal patients with hormone receptor pos, HER2- breast cancer who progress on letrozole or anastrozole?
Generally would not. I usually do Fulvestrant +/- CDK inhibitor if not received in the first line setting, as second line and reserve exemestane to afterwards combined with everolimus. If a patient has minimal disease progression on letrozole/anastrozole and really does not want a monthly injection,...
What systemic therapies would you consider for a patient with HER2 positive breast cancer with progressive brain metastases despite whole brain radiation, but no systemic disease?
This is one of the most challenging scenarios that we face in breast oncology . Radiation therapy remains the mainstay of treatment. For patients with progressive brain mets after whole brain radiation, there may be a role for gammaknife.Regarding systemic therapy, there is a paucity of data regardi...
What systemic therapy would you offer a colon cancer patient after resection of oligometastatic disease that developed while on adjuvant therapy?
Do you ever utilize an anthracycline based regimen rather than a non-anthracycline based regimen for patients with locally advanced HER2 positive breast cancer?
I do not use a lot of AC-THP except in a few cases where we had multicentric or multifocal locally advanced breast cancer that had both HER2+ and HER2- disease concurrently so we had to "cover our bases" for both disease types so to speak. For straightforward HER2+ disease, the 3-year EFS data from ...
Would you continue her 2 neu directed therapy for a patient with breast cancer if a biopsy on progression confirms Her 2 neu negative disease?
There is no good evidence-based answer to this question even though biomarkers (ER, PR, HER2) can change over time (eg. from primary to metastatic recurrence, or pre and post neoadjuvant therapy) in 5-30% of cases.1 There are no large series assessing outcomes based on changing or not changing thera...
Would you consider localized therapies such as radiofrequency ablation to a lung metastasis or Yttrium-90 for liver metastases for disease control for ER+HER2- breast cancer patients with visceral oligometastatic disease who have progressed on all hormonally-targeted therapies and have chemotherapy as their next standard-of-care systemic treatment option?
If truly oligometastatic, then yes I would consider it. Would do a PET-CT plus bone scan to make sure no other site of disease beforehand. Would consider duration of disease free survival before making a decision. If patient has been disease free for a long time, I would consider treatment of oligom...