Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Is it safe to use medroxyprogesterone for vasomotor flushing?
There are many options for management of hot flashes including venflaxine and gabapentin being most frequently used as well as some data on cognitive behavioral therapy, oxybutynin, and acupuncture. For the most refractory cases, I do discuss medoroxyprogesterone 400 mg IM as a one time option based...
How, if at all, does the spectrum of HER2 positivity impact efficacy of T-DXd in the frontline setting?
Multiple studies have shown that HER2 3+ disease is a predictor for exceptional (long-term) response to first-line THP, and conversely, patients with HER2 2+/FISH positive disease are less likely to experience an exceptional response to THP. While I have not seen a subset analysis by HER2 2+ vs 3+ p...
Should we be utilizing prophylactic G-CSF in our patients with intermediate risk of febrile neutropenia due to the COVID-19 pandemic?
There are many functions of G-CSF, including repression of T-cell and NK cell function. Unless you are certain that growth factors are not modifying the immune network to the detriment of viral clearance—there is no data that growth factors help clear viral infections.
Given results of the IDEA study presented at ASCO, would you consider truncating adjuvant therapy with stage II colon cancer?
The question asked is how one would consider incorporating the recent findings from the IDEA study into the utilization of adjuvant chemotherapy for patients with stage II colon cancer. The findings from this landmark study indicated that under certain circumstances, specifically those of patients w...
What screening tools or signs do you use to predict if a cancer patient is near end-of-life?
For most of us, long-time practicing oncologists, all we have to do to determine that one of our patients is at the end of their life is to be in the same room with them. No special computer programs or calculators are needed. Just look closely at the patient's current weight, their level of conscio...
What screening tools or signs do you use to predict if a cancer patient is near end-of-life?
For most of us, long-time practicing oncologists, all we have to do to determine that one of our patients is at the end of their life is to be in the same room with them. No special computer programs or calculators are needed. Just look closely at the patient's current weight, their level of conscio...
What disease characteristics will guide your choice of alpelisib plus fulvestrant (per SOLAR-1) versus capivasertib plus fulvestrant (per CAPItello-291) in PIK3CA mutated advanced ER+/HER2- breast cancer after progression on 1L ET regimen, given both are now approved in this population?
In the absence of head-to-head comparison, I would use cross-trial comparison to compare the efficacy and safety of alpelisib vs capivasertib. mPFS are similar for both: HR 0.65 (11 vs 5.7 months) for alpelisib (SOLAR-1); and mPFS HR 0.6 (7.2 vs 3.6 months) for capivasertib (CAPItello-291). Therefor...
What are the current official guidelines regarding managing patients during COVID-19?
Here are some guidelines and FAQ from professional societies: NCCN: https://www.nccn.org/covid-19/default.aspx ASTRO FAQ: https://www.astro.org/Daily-Practice/COVID-19-Recommendations-and-Information/COVID-19-FAQs ASCO Coronavirus Resources: https://www.asco.org/asco-coronavirus-information
What is the drug of choice in order of preference for neuropathy associated with different agents used for breast cancer treatment?
Unfortunately, many of the large trials have not identified a strategy that is effective for CIPN. It is important to tell patients to avoid some supplements. Studies have shown that acetyl-l-carnitine can make the symptoms worse. There is some evidence that exercise may result in decreased symptoms...
How do you approach an otherwise healthy patient with an incidental 1 mm GIST involving the serosal surface in terms of staging workup, EGD, and surveillance?
We will need more information like location and mitoses per 50 HPF (or 5 mm). Please use the Sloan Kettering nomogram to determine the risk of relapse. Seems like a very low risk of relapse. NCCN recommends 6-month scans for the first 2 years and then once a year to finish 5 years. There is no need ...