Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Is there a degree of osteoporosis (based on T-score) that would prohibit you from the utilization of an AI in a strong HR+ early stage breast cancer?
Tamoxifen is often underutilized in many patients who otherwise have a narrow benefit/risk ratio from an AI. It is more preserving and more tolerated, and should be used more readily in the majority of patients with lower risk disease. Using a sequence of tamoxifen and an AI is also very reasonable ...
How would you advise a woman who had a full axillary lymph node dissection on the risk of lymphedema with mountain climbing?
Well, this is obviously a question with no evidence based answer. Overal, the risk of lymphedema after axillary LN dissection is around 20-25%. Most likely these patients will receive regional LN radiation (due to positive LN's) and the risk will increase to 25-30% (Warren et al). Other risk factors...
How early have you been able to detect a response with CAR-T in patients with relapsed DLBCL?
Responses to CAR-T cell therapy is generally very rapid. As seen in the ZUMA-1 trial median time to response was 30 days. Having said that there are patients in whom continued responses can be seen as late as 5-6 months post therapy, so patient who are in a PR at 1 month, it may be reasonable to jus...
If you decide to discontinue TKI after prolonged molecular remission in CML, how often would you follow the BCR/ABL after discontinuation?
The NCCN has updated the guidelines and included specific and detailed criteria for TKI discontinuation. Per the NCCN guidelines: "Monthly molecular monitoring for one year, then every 6 weeks for the second year, and every 12 weeks thereafter (indefinitely) is recommended for patients who remain in...
Do you use gene expression profiling for premenopausal women with hormone receptor positive breast cancer with 1-3 positive lymph nodes?
I do use gene expression profiling in premenopausal women with 1-3 nodes positive.Premenopausal women represented 33% of all women in MINDACT (NEJM, 2016) (about 2100, a substantial number) and more than half of these premenopausal women had low genomic risk (and therefore a median 5 year distant di...
Would you use 6 months (instead of 12 months) of trastuzumab for locally advanced Her-2 positive breast cancer patients?
I would not recommend 6 months of maintenance trastuzumab for higher risk patients, such as one that received neoadjuvant therapy. The PERSEPHONE trial1 had as its strength its large size and sufficient number of events for a conclusion regarding the population tested (and the diversity of regimens ...
In light of the recently published CARMENA trial, is there still a role for cytoreductive nephrectomy in metastatic RCC patients?
Several features of CARMENA make the data not applicable to all mRCC patients with primary in place. These include a large percentage of poor risk/poor PS patients, lack of receiving intended protocol therapy, including delayed nephrectomy in almost 1 of every 5 patients, and a primary tumor burden ...
Does Keynote 189 establish combination chemoimmunotherapy as the standard of care for Stage IV lung adenocarcinoma?
If the Insigna trial is available, to me that is the best way of addressing this. Otherwise I would not. To me KN189/407 represents the current standard of care in the US relative to KN42 which appears inferior. For those that make argument about patient with poor performance status etc for KN42, th...
What is your current preferred approach in the management of metasatic sarcomatoid NSCLC?
This is certainly a very relevant question not just as to the proper management of pulmonary sarcomatoid carcinoma but also other rare cancer subtypes in general where it is hard to know how to properly utilize information obtained on more common subtypes of the same malignancy. Many times we have t...
For patients with distal esophageal adenocarcinoma who are not surgical candidates, how do you decide between the preferred chemotherapy regimens when given as definitive chemo-radiation?
My regimen of choice has fluctuated over the years. At MSKCC, our institutional standard was previously cisplatin/irinotecan (Ilson, Cancer 2012). This was abandoned after the results of the CROSS study were presented in 2010, establishing a global benchmark for tolerability and a highly respectable...