Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How would you approach a chronic phase CML patient who is responding to second generation TKI but not yet in molecular remission and is now pregnant?
If the patient is now pregnant, I would stop the TKI immediately, and initiate therapy with interferon. If that is not tolerable, I'd recommend hydroxyurea, although it will likely not control relapse into overt chronic phase.
How do you manage a patient with a history of non-seminomatous germ cell tumor who has a rising AFP after primary chemotherapy without any imaging evidence of recurrence?
It would depend on the timing of the rise of AFP after chemotherapy, how elevated it is, whether they were good or poor risk patients at the time of chemotherapy, whether they had liver disease and whether the AFP was definitively elevated prior to chemo In most cases, we sort of ignore AFP < 25 or ...
For male patients in chronic phase CML on a TKI and not yet in a MMR, is there a preferred amount of time spent in a MMR before discontinuing TKI therapy to conceive or bank sperm ?
Hard to answer this one. My preference would be that the patient be in MMR confirmed by two readings three months apart before experiencing a dose interruption.
Would you ever omit adjuvant therapy for rectal cancer in patients who underwent primary resection (TME), without any neoadjuvant therapy?
What is your approach to the upfront treatment of anaplastic large cell lymphoma, ALK positive, with low IPI score in a young person?
ALK positive ALCL is the most responsive of the aggressive PTCL’s to chemotherapy, and the majority of young patients can be cured with an anthracycline containing chemotherapy regimen. Either CHOP or CHOEP (ie CHOP plus etoposide) are frequently used. In a young healthy patient I favor CHOEP based ...
Would you use ado-trastuzumab as first line therapy for metastatic Her2+ breast cancer in a post-menopausal woman who developed metastatic disease years after finishing dual Her2 directed therapy?
The FDA label provides for upfront useage of TDM1 if the patient develops metastatic recurrence within 6 months of adjuvant therapy. In this case since it has been years i would try dual blockade with TPH again as the patient may respond again.
Do you rely on Ki67 as an estimate of proliferation to guide the decision for chemotherapy in premenopausal women with hormonally-driven breast tumors?
Far from it. Especially in premenopausal women, Ki-67 is affected by circulating hormones and time of the month, and it is not a reliable indicator of endocrine resistance. In postmenopausal women, the most valuable Ki-67 reading is on endocrine therapy if any, not baseline either. Ki-67 should not ...
Do you recommend adjuvant or indefinite systemic therapy after surgery/radiation for patients with synchronous bilateral breast cancers that are of the same histology and receptor status?
Synchronous bilateral breast cancer is rare and often presents with concordant histology, but is generally considered 2 primaries rather than metastatic disease due, possibly, to common exposures of similar clones. Despite controversy and conflicting reports, long term survival has been reported. It...
How do you manage rituximab-induced neutropenia?
Rituximab induced neutropenia is a relatively rare but well known phenomenon and can occur in the immediate post treatment period as well as a late sequela of rituximab treatment. In my experience, patients often improve with administration of G-CSF. In cases where a patient's ANC remains <500, I co...
Would you use a platinum containing regimen in the adjuvant setting for a triple negative breast cancer patient with contraindications to anthracycline based therapy?
The question specifically pertains to a patient with contra-indication to anthracyclines. However, I will try to provide my opinion on various situations. 1. I generally do not use carboplatin in adjuvant management of triple negative patients who have contra-indication to anthracyclines. I just us...