Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
In a patient with metastatic HR+ breast cancer progressing on single agent AI, would you use a different AI with CDK4/6 inhibitor?
I doubt that changing the AI would make a difference - in the EFECT trial, patients progressing or recurring on a nonsteroidal AI had a 3.7 month median TTP on exemestane (JCO 2007) (meaning that many patients had progressed by their first reassessment. The more intriguing question is the potential ...
How do you counsel a patient with a history of breast cancer regarding use of breast MRI for screening?
In our Breast Survivorship Clinic at MD Anderson we do not regularly recommend a surveillance breast MRI to screen for local recurrence or for new breast cancer in all of our breast cancer survivors, since there is lack of data to support this practice. Not to mention the elevated cost and the possi...
Would you consolidate marginal zone lymphoma transformed to a high grade B-cell lymphoma with a stem cell transplant?
The transformed lymphoma that develops out of indolent small B cell lymphoma such as marginal zone lymphoma, follicular lymphoma or lymphoplasmacytic lymphoma, is typically diffuse large B cell lymphoma (DLBCL). When this type of transformed DLBCL develops in a patient who has not previously receive...
What is your preferred chemotherapy regimen to give concurrently with radiation for unresectable stage 3 NSCLC?
I have generally preferred the cisplatin/etoposide regimen, in part due to the "consolidation" portion of the weekly paclitaxel/carboplatin regimen (ie in patients who could tolerate cisplatin based regimen, it seems preferable to be done after six weeks rather than 12 weeks). That being said, I do ...
How do you minimize the risk of cardiotoxicity in metastatic Her2 + breast cancer patients who are receiving trastuzumab and have a history of pre-existing cardiac disease?
Currently there are no proven strategies that are widely used to minimize the risk of cardiac toxicity in patients receiving Her2 therapy. Development of inexpensive, protective regimens with minimal side effects for patients at risk for cardiac dysfunction and the devlopment of models identifying w...
Do you have a preferred regimen for patients with HER-2 positive metastatic breast cancer who have progressed through THP followed by T-DM1?
3rd line and beyond for Her-2 disease is a bit of an open playing field, especially compared to our scripted THP and T-DM1 in the 1st and 2nd lines respectively. Many use capecitabine + lapatinib, or another chemotherapy backbone and revisit trastuzumab (such as navelbine/trastuzumab, or gem/trastuz...
How do you balance aspiration risks with encouraging PO intake for HN cancer patients during and after chemoradiation?
The main challenge is to identify the patients who are most prone to aspirate during and after Tx. Chemo-RT-related aspiration is frequently “silent”: the patient does not recognize he/she aspirates, and neither does the observer. The risk of aspiration is assessed by modified barium swallow perform...
What is the rate of a cardiac events that you quote to a patient with preexisting heart disease going on trastuzumab for metastatic Her2+ breast cancer?
I tell patients that it depends on their baseline risk factors and that some have reported rates as high as 25-28%. I discuss that if they have had prior anthracycline therapy, borderline baseline LVEF (50-54%), age > 65, and other cardiac risk factors like hypertension, that they could fall into th...
How would you approach the adjuvant management of locally advanced pancreatic neuroendocrine tumor s/p resection with positive margins and positive lymph nodes (high lymph node ratio, + LVI, low grade and well differentiated)?
We know that the factors of positive margins, positive lymph nodes and LVI all confer a heightened risk of relapse. It is critical to ensure good post-operative staging and I would suggest a multiphase CT, Gallium 68 Dotatate scan and Chromogrannin A. If there is no evidence of residual disease, we ...
Would you use apalutamide in high risk non-metastatic castrate resistant prostate cancer?
I would consider using apalutamide for the appropriate patient, which I would define as meeting the entry criteria for the study i.e. PSA DT 10 months or less. The label for the drug is broad i.e. any castration resistant PSA only patient, which I beleive is too far to inclusive, many of these folks...