Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
What is your preferred first line systemic therapy for metastatic chordoma?
Should high-dose methotrexate be used in the treatment of AYA patients with osteosarcoma?
It has been our practice to use high dose methotrexate (HDMTX) in the treatment of our AYA osteosarcoma patients. Methotrexate has been an important component of most osteosarcoma treatment protocols for many years and is generally considered part of the standard of care for this disease (Grem et al...
After an optimal tertiary cytoreduction for recurrent granulosa cell tumor previously treated with BEP and hormonal therapy, would you recommend systemic chemotherapy?
Yes, I would give adjuvant therapy. I would go with carbo taxol. The MD Anderson people have been using this regimen for some time. It is less toxic and appears to be as active as BEP. I think Jubilee Brown published a paper on this subject recently. This exact meeting was not specifically addressed...
Do you avoid immunotherapy in patients with Stage IV NSCLC with atypical EGFR mutations such as G719S or S768I?
This is a difficult situation, but typically I would try to treat patients with an EGFR TKI (ideally in the context of a clinical trial) or with afatinib. Pooled data from the LUX-Lung studies [Yang et al., PMID 26051236] demonstrated an ORR of 71%, PFS 10.7 months, and OS of 19.4 months for Group 1...
Would you avoid capecitabine in favor of fluorouracil in the adjuvant treatment of colon cancer for a patient with history of a gastric bypass?
Yes, that would be a good reason to use adjuvant infusional 5FU over capecitabine due to concerns about absorption. In general, 6 mo of FOLFOX would be used in lieu of 3-6 months of adjuvant cape/ox. Here is a reasonable resource for this decision, showing faster absorption of capecitabine in gastre...
How would you manage a patient with history of stage IIIC HGSOC after secondary cytoreduction of isolated inguinal node recurrence 12 years after primary treatment?
Difficult case. Could just observe if the lymph node is an isolated recurrence with no extracapsular extension. If extracapsular extension, could offer standard chemotherapy again, or just single agent carboplatin to minimize side effects x 6 cycles. This patient should have been extra-sensitive to ...
Would you recommend aspirin 600 mg daily for two years to a patient with Lynch syndrome and a history of colon cancer based on the results of the CAPP2 study for cancer prevention?
Yes, I would recommend this, with some caveats/considerations. 600 mg of aspirin daily x 2 years was the dose/duration shown to be effective in CAPP2--recently updated outcomes data from this trial (Lancet 2020) demonstrated an IRR of 0·50 (0·31–0·82; p=0·0057) for CRC among participants who were ab...
What would be the ideal patient to receive selinexor-based therapy over other options for penta-refractory multiple myeloma?
Selinexor makes sense in combination with a partner, usually, either Carfilzomib or Pomalidomide, after patients are refractory to RVd --> Dara-Pd --> KPd --> Belantamab. An alternate route might be Dara-Rd --> KPd or PVd --> Bela. In essence, Selinexor is what I use when there's nothing left standa...
In a patient with breakthrough VTE on rivaroxaban, would you switch to apixaban or an agent with a different mechanism of action?
A complex situation and a lot will depend on the clinical circumstances e.g., compliance, type of failure, etc. I would still consider apixaban. However, if the failure was a more serious event, consider alternative anticoagulants.
Are you selecting any specific patient cohort with metastatic NSCLC for treatment with the CheckMate 9LA protocol of ipilimumab + nivolumab + 2 cycles of chemotherapy?
I am not currently using this regimen although, it is certainly an acceptable regimen.