Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Do you ever consider local therapy to oligometastatic hormone-receptor positive breast cancer?
Surgery or radiation therapy in metastatic breast cancer patient is one of hot topics in care of the patients with stage IV disease, especially since the survival of oligometastatic breast cancer and widely spread metastatic breast cancer is vastly different. For instance, the 5 year survival of oli...
What is the your choice of treatment after progression or AE following pembrolizumab in metastatic melanoma?
There is unfortunately limited prospective randomized data to guide us after progression due to anti-PD-1 therapy in metastatic melanoma. There is little benefit to re-challenging with the other anti-PD1 therapy (pembro or nivo after nivo or pembro etc) and dependent on AE would most likely not re-c...
How would you manage papillary variant squamous cell carcinoma of the oropharynx?
We prefer to approach papillary variant squamous cell carcinoma with a surgical approach. These cancers can be related to HPV (either high risk or mucosal subtypes) and generally carry a good prognosis. A selected neck dissection should be considered and if the tumor is larger or more invasive than ...
What is your preferred approach to the treatment of transplant ineligible multiple myeloma that has been treated with a triplet regimen and reached a plateau phase?
The depth of response translate into better PFS and OS. Partial response is not appropriate today. We have better combinations that can lead to that. We need to get our patients into CR as soon as possible. After we are there we can talk about maintenance.
Would you use trastuzumab with chemotherapy in a patient with metastatic gastric cancer that is HER2 negative but ERBB3 positive?
No, there are clearly no validated data for this and I do not have any anecdotal experience to suggest benefit. Such a patient should be referred for studies of pan-ErBB inhibitors, e.g. afatinib or neratinib.
In classical hodgkin's lymphoma patients with a postive PET after 2 cycles, are you routinely transitioning to escalated BEACOPP?
Based on the study by Johnson Et al. NEJM 2016 that would be an appropriate action and a strategy that most academic centers undertook prior to the Echelon 1 study. This early in the treatment algorithm to consider either agent although you could consider the combination based on the recent blood p...
What is your approach to treating newly diagnosed plasma cell leukemia?
For fit patients, I am very aggressive in treatment; I use VDTPACE x 2 cycles followed by tandem transplant, then maintenance therapy using a PI and an IMiD, per our observation that showed better results comparing to those who had one transplant. I had no updates on newer agents to use upfront such...
What do you advise young low-risk pre-menopausal patients requiring adjuvant hormonal therapy who have endometriosis and are worried about the effects of Tamoxifen?
This is a situation where risks and benefits must be weighed for each scenario so the providers (gyn,med onc) and patient can make the therapy decision together. Low risk can mean different things and that can influence the decision for therapy. Is it low absolute risk with (T2N0 low oncotype dx) or...
Do you give systemic therapy for triple negative breast cancer with brain metastasis and no other sites of disease?
The occurrence of the isolated brain met is assumed to be in a TNBC patient who was diagnosed previously with non metastatic breast cancer and was treated with curative intent (not de novo). The most likely scenario is that the patient harbors occult residual disseminated tumor cells in the marrow w...
Do you routinely do imaging on patients to look for intrathoracic or abdominal lymphadenopathy in newly diagnosed patients with CLL?
As a general rule, I do not routinely obtain CT imaging studies in all newly diagnosed CLL cases, noting that the Rai and Binet staging systems still widely used today are based on clinical assessments of palpable lymphadenopathy and splenomegaly, and do not require radiographic imaging for completi...