Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Would you treat a patient with HIV or hepatitis C with an anti-PD-1 agent?
Yes, anti-PD-1 agents can be used in patients with HIV or hepatitis C if the viral infection is well controlled. In preclinical studies, PD-1 blockade has been shown to be a promising immunotherapy for HIV and Hepatitis C. This is based on the observation that progressive loss of effector function i...
Would you recommend prophylactic mastectomy if a patient's estimated lifetime risk of breast cancer using the Gail or Clause models approaches that of a person with a germline BRCA1 mutation (eg >65-85%), in the absence of high risk mutations?
It is premature to recommend prophylactic mastectomies to this patient. The recommendation would be for recommendation of expanding genetic testing in the affected mother or sister utlizing a larger panel of breast cancer susceptibility genes, if they are available for testing and amenable to do so....
Would you consider first-line cabozantinib in patients with intermediate- or poor-risk mRCC?
Although the results from the phase II CABOSUN trial were intriquing, I would not consider cabozantinib as first line therapy for patients with intermediate or poor-risk mRCC. There were a number of concerning results. Firstly, the extremely low PFS of ~5months in the sunitinib-treated patients is m...
How would you treat small cell cancer of the cervix?
Small cell carcinoma is a rare tumor, representing less than 3% of all cervical cancers. It is tremendously different from the more common squamous and adenocarcinomas of the cervix both in terms of histological identification and its clinical course. Due to its rarity and variable inclusion on prev...
In what situations should chemotherapy be added to adjuvant radiation therapy in a resected vuvlar SCC?
We did analysis from NCDB and saw significant trend of use of concurrent chemotherapy for node positive disease and its positive impact on survival. That being said these studies have their own flaws. In practice we do add concurrent cisplatinum for node positive patients if performance status allow...
How would you manage positive surgical margins after partial nephrectomy for kidney cancer?
If feasible, I would recommend re-excision. This is not always feasible however, and in that case, I would observe. Patients with positive margins do not always recur and thus could spare the patient some toxicity.
How do you approach maintenance therapy for relapsed follicular lymphoma?
In general, patients who received 2 years of maintenance rituximab in first-line settings are unlikely to benefit from more maintenance rituximab in second-line. This is especially true if relapse occurs within 24 months of first-line therapy.A meta-analysis (JNCI 2011) did show a small benefit in o...
How do you treat hiccups in cancer patients?
Personal success has lead me to use Baclofen to control chemotherapy induced hiccups. A single 10 mg dose is usually effective for patients who experience hiccups upon administration of chemotherapy. Occasionally 10 mg q 8 h prn is needed for a few doses. I have seen this side effect and used Baclof...
Would you consider treatment of advanced HCC with checkpoint blockade after progression on sorafenib?
Yes, I would consider checkpoint blockade, particularly a research protocol. HIV status may complicate trial enrollment but would not necessarily be an issue off study. Hepatitis status as a predictive factor for response is interesting and is being currently investigated. In my practice, we conside...
How do you treat GIST with de-differentiation to pleomorphic sarcoma on chronic therapy with imatinib?
Once a GIST, always a GIST. Sarcomas that are driven by a translocation can behave badly but they never ever get rid of their translocation. Possibly by saying the GIST has de-differentiated your pathologist is telling you the GIST looks more aggressive. Or maybe it was never was GIST in the first p...