Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Which chemotherapy regimen do you prefer for concurrent treatment with radiation therapy for anal squamous cell carcinoma?
When you have a highly successful treatment such as radiation with concurrent mitomycin and 5-FU in a rare disease such as epidermoid carcinoma of the anal canal, it is extremely difficult to improve outcomes by improving the chemotherapeutic/radiosensitizing effect. The recurrence rate is so low no...
Are there any situations where you would you add docetaxel to gemcitabine + capecitabine for locally advanced unresectable pancreatic cancer?
Do you recommend adjuvant chemotherapy for local relapse of invasive lobular carcinoma after surgical resection?
This one often depends on the nature of local relapse and whether relapse occurred on ET. The CALOR trial as flawed as it was suggested that chemotherapy helps in the "repeat adjuvant" setting, however that benefit appeared mostly in HR-disease. That said, lobular cancers are not chemotherapy insens...
When do you consider it too late after surgery to offer adjuvant chemotherapy for colon adenocarcinoma?
Retrospective studies suggest that there are diminishing returns for adjuvant chemotherapy beginning 2-3 months after surgical resection. This is almost certainly a continuous variable, so I don't interpret this data to mean that one should never consider adjuvant chemotherapy after that time point....
Should NSCLC with positive cervical nodes be managed with definitive chemoradiation?
The AJCC staging system in conjunction with the IASLC lymph node map is quite clear on this issue. Cervical lymph nodes are non-regional and in the TNM classification are noted as M1b or stage IV. From a practical standpoint though, one should consider the number and location of the lymph nodes in q...
Do you recommend starting sorafenib at a reduced dose and titrating up in patients with advanced hepatocellular carcinoma?
Yes, I do. In our recent, large retrospective analysis of nearly 5,000 patients with HCC, we noted that starting at a lower dose of sorafenib and titrating up as tolerated (1) did not adversely affect OS and (2) resulted in less toxicity and cost to patients (Reiss et al, JCO). In this setting, I th...
How long do you give adjuvant hormonal therapy for women over 70 with breast cancer treated with lumpectomy only?
It is always difficult to make a recommendation for endocrine therapy duration when optimal duration is unknown. Looking at CALGB 9343 (Hughes et al, JCO 2013), in which women with stage I cancers were randomly assigned to either tamoxifen plus radiation or tamoxifen alone, we know that the risk of ...
Can patients on steroids receive immunotherapy?
In general, it is acceptable to be on the equivalent of 10 mg/day of prednisone (at least this is what has been the cutoff used in most of the trials). Also, patients on replacement doses (presumably of hydrocortisone) for adrenal insufficiency are, of course, also proper treatment candidates for ch...
Would you feel comfortable giving a HER2+ breast cancer patient her next cycle of TCHP (Taxotere + carboplatin + Herceptin + Perjeta) on day 17 of the previous cycle?
No. I usually delay chemo but never give chemo a week prior to the scheduled time. I can try a day prior. I'm worried about unnecessary toxicity in such a setting. Remember, adjuvant or neoadjuvant therapy is given to optimize the cure. You don't want to create lasting toxicity or place a patient at...
What adjuvant therapy would be recommended for node positive gastric adenocarcinoma s/p gastrectomy, in a patient who did not receive neoadjuvant therapy?
The 4 studies that provide guidance for adjuvant treatment are chemotherapy only (ACTS-GC and CLASSIC with 1 year of S-1 and Capeox respectively)chemoradiation (US INT 116 for bolus 5-FU/leucovorin before and after chemoradiation with 5-FU) and chemotherapy with or without chemoradiation (ARTIST stu...