Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Would you ever NOT recommend adding concurrent chemotherapy to adjuvant radiation in +ECE oropharynx SCC patients who can tolerate it?
For now, always CCRT post op for ECE.
Under what circumstances do you consider double autologous stem cell transplants for patients with multiple myeloma?
Never. The data for tandem transplant shows a modest PFS but not an OS advantage. Indeed, OS maybe worse with tandem transplant. It’s hard to justify the toxicity of an additional transplant if there is no OS advantage.
Would you ever start radiation in the middle of cycle 1 of chemotherapy for LS-SCLC?
The goal is to get RT started early in the course, and to maximize the concurrent part of the therapy. But of course a patient only gets chemo for a few days per cycle, and we don't know whether the ‘concurrent’ effect is entirely due to those days treatment, or whether the radio-sensitizing effect ...
What are some preferred steroid sparing regimens for untreated multiple myeloma patients who have type 1 diabetes mellitus?
The amount of dexamethasone used in current regimens is less than historical regimens of 40 mg daily x 4 days, etc. based on an ECOG trial comparing 40 mg weekly to the older standard (both in combination with Revlimid) https://www.ncbi.nlm.nih.gov/pubmed/19853510. Nevertheless, the amount is still ...
How do you manage non-mucinous metastatic appendiceal adenocarcinoma?
The treatment algorithm for advanced, non-mucinous appendiceal adenocarcinoma is essentially identical to the algorithm for advanced colon adenocarcinoma (including the selective use of metastasectomy to render patients disease-free).
How will you decide between mFOLFIRINOX vs gemcitabine+capecitabine for resected pancreatic cancer patients?
The results of the PRODIGE-24 trial are among the most significant of the last quarter century in terms of their impact on the treatment of patients with pancreatic adenocarcinoma. The administration of mFOLFIRINOX resulted in almost a doubling of 3 yr DFS (the primary endpoint) and also extended th...
Is there any benefit to adding bevacizumab to chemo-immunotherapy in metastatic NSCLC?
In the ITT population of the Impower 150 trial the median OS was 19.2 mo on arm B (Atezo + chemo + bev) and 14.7 mo on arm C (chemo + bev) with a Significant HR of 0.78 but the mOS in arm A (atezo + chemo) was 19.4 mo with no planned comparison to arm B but seems not to be significant. So the presen...
Would you try abemaciclib in a woman on fulvestrant and palbociclib with good systemic control but progression in the brain?
I believe this is a reasonable option as treatment of Brain metastasis remains challenging despite advances in the management of metastatic HR + breast cancer. Abemaciclib, currently approved for the treatment of HR+ metastatic breast cancer (MBC), has been shown preclinically to cross the blood-bra...
How would you approach locally advanced bladder cancer in a patient on hemodialysis?
It depends on "locally advanced" setting; resectable or unresectable tumor?If resectable and not metastatic may consider radical cystectomy and LN dissection in good surgical candidates; however bladder preservation approach can be considered in well selected patients, e.g. small unifocal tumors wit...
Would you consider first line therapy with PD-1 inhibitors (+/- CTLA4) for patients with metastatic NSCLC with high tumor mutational burden despite negative PD-L1?
I would consider giving a patient with metastatic NSCLC and a high tumor mutational burden despite negative PD-L1 treatment with Nivolumab plus Ipilumumab. I would also consider giving the same patient chemotherapy plus a checkpoint inhibitor alone!The optimal treatment for this patient population i...