Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Do you routinely offer adjuvant chemotherapy to patients with extrahepatic cholangiocarcinoma after R0 resection?
When do you consider re-starting treatment for a patient with relapsed myeloma?
Do you start anti-myeloma therapy when patients have progressive disease (25% increase in paraprotein or new or worsening myeloma bone disease) or clinical relapse (CRAB criteria, hyperviscosity, new plasmacytoma)? The goal is to pull the trigger right before clinical relapse. How is this done in th...
Do you have a cut-off for bilirubin for treatment of patients with poorly differentiated NSCLC with good PS and liver dysfunction due to mets?
The management of patients with extensive liver mets resulting in elevated bilirubin depends upon the clinical scenario. The question posed indicates this patient has a good performance status and a lung cancer histology of "poorly differentiated NSCLC". The factors that I would consider when treati...
Do you send Oncotype or Mammaprint as a predictive tool for patients with high grade (3/3) lymph node negative ER+ breast cancers?
No it doesn't overrule. The key question is whether you would predicate chemotherapy use according to the genomic test estimates of prognosis with ET alone (oncotype, mammaprint, prosigna, EPclin etc).
How do you choose a dose of 5-FU during chemo-radiation for a patient with rectal cancer who is dialysis dependent?
5FU is not cleared by the renal excretion and does not require dose modification. I would tend to use the doses in the NSABP R-03 trial, 225 mg/m2/day continuously. Other published doses or bogus schedules may be equally used without dose modification. However capecitabine is cleared renally and sho...
For triple positive metastatic breast cancer, do you sequence or simultaneously use hormonal therapy along with chemotherapy?
There is little evidence to support concurrent administration of endocrine therapy with chemotherapy or chemotherapy plus anti-HER2 therapy, in metastatic breast cancer. Sequential use of endocrine therapy after completing a course of chemotherapy/anti-HER2 therapy is a reasonable alternative that m...
Do you prefer a chemo-radiation combination or chemotherapy followed by sequential radiation approach for early stage NK/T-cell lymphoma?
If SMILE regimen is used here (the preferred regimen for NK/Tcell lymphoma), radiotherapy should be delivered sequentially (not concurrent) due to normal tissue toxicity and poor tolerance.
What alternative therapies would you consider for a patient with metastatic castration-sensitive prostate cancer who declines GnRH analogues?
This situation is fairly uncommon, particularly in the metastatic setting, where these therapies are nearly universally effective and toxicities generally manageable. The alternatives of bicalutamide at high dose (150 mg/d) and enzalutamide also have toxicities and much less evidence to support thei...
How would you treat a premenopausal patient with ER/PR+, Her2 (-) metastatic breast cancer patient who progresses on tamoxifen?
I would give her maintenance fulvestrant high dose with palbociclib given she had progressed on tamoxifen (so combination anastrozole and fulvestrant maintenance will not be an ideal choice). While neither S0226 (first-line and few with acquired or innate resistance) and Paloma 3 (second line or fir...
What is your preferred regimen for triple positive breast cancer with bone only recurrence?
The primary options for triple positive MBC is whether to use antiestrogen approaches alone or with antiHER2 therapy, versus chemotherapy + HP. Indolent disease with bone-only involvement is the group for which antiestrogen-based approaches alone could be considered, although two randomized studies ...