Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
What is the preferred palliative treatment regimen for elderly patients with advanced cholangiocarcinoma?
There is very limited data to provide a data driven approach to the management of elderly patients with advanced cholangiocarcinoma. In my clinical experience, gem/cis combinational chemotherapy as given in the ABC-02 trial is well tolerated for most older adults with preserved performance status an...
Is there a difference in the durability of CR based on the dosage of pembrolizumab used in metastatic melanoma?
This a great question and highlights the drug dosing and development process of the use of Pembrolizumab in metastatic Melanoma. In Keynote-002, Pembrolizumab was studied in the does of 2mg/kg and 10mg/kg vs chemotherapy and the CR responses were 2 vs 3% in the Pembrolizumab arms. In Keynote-006, Pe...
Are you considering the use of circulating tumor DNA or circulating tumor cell count to make clinical decisions in the adjuvant setting after colon cancer resection?
Circulating tumor DNA (ctDNA) has become commercially available with several NGS panel sequencing 70-100 genes. It is somewhat of interest in determining resistance to anti-EGFR drugs for advanced disease patients, as transient RAS mutations may emerge and then recede.In the adjuvant setting, one st...
Can denosumab be given every 3 months?
Not without data. The long half life and persistence of bisphosphonates in the bone is different from the shorter half life of monoclonal antibodies targeting RANK ligand (32 days). So dosing denosumab 120mg every 3 months would probably lead to suboptimal drug levels and increased bone turnover. Wh...
How do you approach a tumor that has been reported as HER2 amplified based on IHC 3+, but further testing with FISH is negative?
Treat as Her2 positive. There is no need to do a FISH test if IHC is 3+. Positivity by either method has shown benefit.
What factors might influence your initial treatment decision of oligometastatic NSCLC assuming good performance status, lack of actionable mutation, and PD-L1 status < 50%?
When do you use immunotherapy with MSI high advanced colorectal cancer?
Based on the available data from the KEYNOTE trials and CheckMate 142, I use immunotherapy in the second-line (or greater) setting. There is no data at this time to support front-line use, so I would only consider that for patients who are not good candidates for combination chemotherapy. KEYNOTE-17...
Do you have a preferred strategy for front line induction therapy in DLBCL patients who have asymptomatic depressed ejection fraction and thus concern about anthracycline dosing?
I generally replace the anthracycline in RCHOP with etoposide 50 mg/m2 IVPB Days 1-3 based on an ASH abstract #408 in 2009 by Sehn L et al. If the day 2 and 3 doses of etoposide are given orally rather than IV the dose would be 100 mg/ m2.
For patients with advanced gastric/GEJ cancer expressing PDL1, is there data to support frontline pembrolizumab?
I agree with Dr. @Dr. First Last's comments regarding the Keynote 059, 061, and 062 studies. However, there are new data presented at the 2020 ESMO meeting. The Keynote 590 is a phase III study enrolled 749 patients with advanced esophageal and GEJ cancer (including esophageal squamous cell carcino...
In what scenario would you prefer to use every two weeks paclitaxel over weekly paclitaxel in the adjuvant treatment of breast cancer?
I prefer weekly taxol and don't use DD taxol often. Sometimes it is patient preferred because of the shorter duration altogether, or if there is a long travel distance then coming less frequently may make sense.