Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Is there evidence of clinical benefit to proceeding with partial pleurectomy / decortication over palliative chemotherapy with BSC (pleurex catheter, pleurodesis) in a patient with mesothelioma who is not a candidate for extra-pleural pneumectomy?
There is no compelling evidence here. The only randomized data are from the UK MesoVATS trial, reported in 2014, showed that patients with pleural mesothelioma randomized to video-assisted thoracoscopic partial pleurectomy/decortication had no difference in 1 year survival compared to those who unde...
When would you consider local ablative therapy (e.g. SBRT, surgery) for patients with oligometastatic non small cell lung cancer on immunotherapy?
Definitely would treat this exactly as I do for EGFR or ALK-targeted therapy. If the patient is doing well, and most sites of disease continue to be controlled but one is progressing I would consider local ablative therapy. That being said, I just had a patient doing well with a CR on ipi-nivo for ...
What strategies do you employ to mitigate mucositis related pain during the treatment of head and neck cancer?
The bottom line is there is no magic bullet that works well. I start Glutamine a week before and throughout the duration of the treatment. It seems to delay the onset. I use custom made mouth pieces to reduce dental scatter if possible--that will reduce mucositis I start with over the counter analg...
What is your approach to patients with locally advanced triple negative breast cancer with residual disease at the time of surgery?
These patients remain at very high risk for metastatic recurrence and therefore should receive adjuvant chemotherapy with capecitabine as standard of care, radiation therapy, and considered for participation in the following adjuvant clinical trials: (1) SWOG S1418 (pembrolizumab versus observation)...
How do you approach non-metastatic castration-resistant prostate cancer?
The two recent placebo controlled trials comparing apalutamide and enzalutamide in M0CRPC (SPARTAN and PROSPER) have shown sizeable and consistent effects on various outcome measures, clearly met the primary study endpoints and hence satisfied FDA regulatory criteria for drug approval in this space....
Is there a preferred neoadjuvant chemotherapy regimen for a marginally-resectable, dedifferentiated, MDM2+ liposarcoma?
In our experience, neoadjuvant chemotherapy alone is unlikely to convert someone from marginally resectable to more resectable. These patients are better served with neoadjuvant radiation therapy with the addition of weekly doxorubicin/cisplatin being an additional consideration.
How do you approach isolated recurrence in a para-aortic lymph node following definitive radiation for localized prostate cancer?
This is a challenging situation with no data to guide therapy; it is not unreasonable to pursue novel PET imaging (PSMA on trial, fluciclovine) to ensure there is no evidence of other sites of metastatic disease. The treatment of oligometastatic disease continues to evolve. In this situation, I woul...
Now that there are three FDA-approved PARP inhibitors for use in ovarian cancer (niraparib, rucaparib, olaparib), how do you decide which one to use?
One, niraparib is only approved for maintenance after treatment of platinum sensitive recurrence. Olaparib and rucaparib are approved for treating active, measurable disease. Olaparib for germline BRCA mutation carriers after 3 prior therapies, rucaparib for treating patients with germline or somati...
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...