Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
What adjuvant therapy would you offer a TNBC patient with residual disease after receiving the neoadjuvant KEYNOTE-522 regimen?
Safety is pembro and cape was provided in phase I trials. Risk and benefit weighing is important when discussing with patients.
Would you change treatment in a patient with metastatic CRPC on PARP inhibitor with rising PSA but negative Axumin PET scan?
Short Answer: No Medium Answer: The surrogacy of PSA as an intermediate endpoint in both localized prostate cancer and metastatic prostate cancer has been problematic. Multiple variations have been explored and tested including PSA doubling time (PSADT), PSA nadir, absolute PSA level, etc. None have...
What are your considerations for choice of immunotherapy agent with patients with metastatic pMMR HER2- esophageal/GEJ/gastric adenocarcinoma with CPS >=10?
I alluded to this earlier. Although both CheckMate 649 and KEYNOTE 590 included esophageal cancer, there were caveats. Specifically, in CheckMate 649, there were relatively few patients with esophageal adenocarcinoma. The positive results of CM-649 were clearly driven by gastric adenocarcinoma, part...
What are your top takeaways from ASCO GI 2022?
1. "NEONIPIGA” GERCOR: While small numbers of patients, they evaluated an immunotherapy combination in MSI-H locally advanced gastric or GE junction cancer. They demonstrated high rates of responses and 59% path CR which is unprecedented in patients undergoing surgery. It raises the question of whet...
How do you adjust Tamoxifen use in HR+ patients with a history of gastric bypass?
No. I do not track levels of tamoxifen in patients who have had gastric bypass. Though I acknowledge that there are reports of tamoxifen being less absorbed in patients after gastric bypass (Willis et al., PMID 20099995), the therapeutic window for tamoxifen is very wide and recurrence after weight ...
What adjuvant systemic therapy would you recommend for a woman s/p ALND for a nodal recurrence of ER-/HER2+ breast cancer 1 year after completing adjuvant therapy with paclitaxel/trastuzumab for her initial disease?
If the axillary nodes were already dissected, I would try TCHP followed by HP since she is pertuzumab naive and she had a DFI of >12 months from paclitaxel. If she had her nodes clipped for neoadjuvant TCHP, I would have switched to adjuvant TDM1 if she had residual disease in the axillary nodes.
Would you consider using HMA in management of polycythemia vera?
The short answer is no. However, it depends on what is going on with the patient and what is meant by refractory? If one is managing symptomatic PV or trying to control counts then hydroxyurea, pegylated interferons, and ruxolitinib are the available options and it is worth mentioning that ropeginte...
In a patient with metastatic HER2 positive breast cancer who has received prior TDM1 in the adjuvant setting for residual disease, would you consider reintroduction of TDM1?
I would consider re-introduction of TDM1 in the subsequent line setting for metastatic, HER2 positive breast cancer as long as disease free interval between completion of TDM1 and breast cancer relapse is has been long enough. I typically think of 1 year or longer between relapse and completion of a...
Is there any role for adjuvant atezolizumab or adjuvant osimertinib in patients who received neoadjuvant chemotherapy for resectable NSCLC?
Most of the neoadjuvant studies using either immunotherapy or targeted therapy before surgery have continued the therapy after surgery in responders. For IO, this has generally been 1 year. For targeted therapy, it may be as long as 3 years.
Are there scenarios in which you would add nimotuzumab to cisplatin based concurrent chemoRT to treat locally advanced head and neck cancer?
Personally, I would not use the combination of nimotuzumab and cisplatin with RT since it is not FDA approved in the United States. There is data to support the combination might be beneficial for patients with locally advanced SCCHN. However, the drug is not commercially available, and most insuran...