Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
What treatment would you offer a patient who underwent surgery for an extrahepatic cholangiocarcinoma and subsequently developed an isolated malignant biliary stricture?
In this case, for an isolated bile duct recurrence, local radiation therapy can be considered. It would be preferred over systemic therapy as radiation therapy can provide long term disease control. The case would have to be discussed with the radiation oncologist regarding feasibility and type and ...
Do you offer maintenance rituximab in transplant ineligible patients with mantle cell lymphoma?
The data on the role of rituximab maintenance therapy in transplant ineligible patients with mantle cell lymphoma are not straightforward to interpret. The most often cited experience (Kluin-Nelemans, et al., PMID 22873532) is a complicated study with two randomizations: induction therapy was either...
Would you use upfront immunotherapy in a patient with MSI high metastatic colon cancer in the setting of high volume disease?
These are challenging. I have used triplet in a couple of these who needed quick cytoreduction and for purposes on neoadjuvant for possible liver resection given the 30 percent primary refractory.
What adjuvant systemic therapy would you offer to a healthy elderly woman with a 5mm, node negative, grade 2 HR+HER2+ invasive lobular carcinoma?
Although several studies have clearly indicated a higher risk of recurrence for early stage HER2+ breast cancers, the absolute risk for T1aN0 breast cancers is still quite low. The studies have been limited by small numbers, but there are retrospective series suggesting excellent outcomes without ad...
How do you use daratumumab in the treatment of systemic AL amyloidosis?
I now routinely incorporate daratumumab into the frontline treatment for AL amyloidosis as well as in the relapsed/refractory setting. The data supporting frontline use comes from the phase III ANDROMEDA study which randomized patients to Dara-CyBorD to CyBorD (cyclophosphamide, bortezomib, dexameth...
How would you modify adjuvant therapy for a patient with ER+ HER2+ breast CA with no response to neoadjuvant TCHP and develops pneumonitis on adjuvant TDM-1?
Retest tissue for Her2. No data for cytotoxic chemo but consider ACx4 and adjuvant Traz/pertuz to complete a year and then perhaps Neratinib especially if ER+ive.
Would you start TKI therapy in a patient with new diagnosis of T-ALL without BCR-ABL gene rearrangement on FISH but found to have very low level p190 transcript on RT-PCR?
I would not. I don't necessarily have any evidence to support this, so this is simply an opinion. I have seen this a couple of times in my clinical practice. If there is truly BCR-ABL present in this patient's leukemia, the level of it would have to be extremely low to only be detectable at this rep...
How would you treat HR positive, HER2 positive metastatic breast cancer in patients with a borderline or poor performance status?
For HR positive, HER2 positive metastatic breast cancer in this patient, I would favor a combination with endocrine therapy + trastuzumab, not chemotherapy plus trastuzumab. This combination has been shown to be more effective versus endocrine therapy alone (Huober et al., PMID 21862331) and is incl...
How do you approach missed doses of durvalumab consolidation in patients with Stage III NSCLC?
This is a common topic that comes up in clinic. In a previous question, the discussion centered around when/if to resume durvalumab if treatment was held due to toxicity. Here, I assume missed doses occurred for non-irAE reasons. Personally, I discontinue treatment at the completion of 1 year of the...