Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How would you manage adjuvant treatment of a premenopausal woman with HER2 positive, ER/PR negative multifocal micro-invasive node-negative breast cancer?
I would not typically recommend any adjuvant chemotherapy + HER2 directed therapy for a T1mi N0 breast cancer. For T1a, the risk of distant recurrence also is likely low based on observational series, so observation is also reasonable. However, as per NCCN guidelines, it is also appropriate to consi...
Assuming a clinical trial is unavailable, would you consider tazemetostat in a patient with metastatic INI1/SMARCB1 deficient sinonasal carcinoma?
I would certainly consider Tazmetostat for INI deficient SNUC, if progressed on front-line therapy and no trials available.
Does discovery of clonal hematopoiesis on liquid biopsy for solid tumors change your treatment approach in terms of which chemotherapy to offer for the solid tumor?
CHIP findings are relatively common. A small percentage of patients with CHIP abnormalities will evolve into a Hematological malignancy depending on the mutation in the 1-2% range. I am unaware of any data that indicates that this percentage increases due to treatment for solid tumors. Therefore, I ...
How would you treat an elderly female with residual TNBC following surgery and neoadjuvant Carboplatin and Paclitaxel?
I think there will be some differing opinions on this. There are a number of things I would factor in assuming the patient has enough life expectancy where the breast cancer is the main mortality risk. 1) Data from carbo/taxane neoadjuvant trials (Sharma et al CCR 2018) and others suggest RCB1 patie...
Does cytoreductive therapy in high risk PV reduce thrombotic events because of better normalization of blood counts as compared to phlebotomy, or through some other mechanism?
I suspect that several factors contribute to the decrease in thrombotic events. First, more consistent normalization of blood counts. However, probably more importantly is the reduction in inflammation. This would be supported by the lower thrombotic events in patients on ruxolitinib vs standard the...
What treatment would you consider for metastatic urachal carcinoma following progression on FOLFOX and FOLFIRI?
Metastatic urachal adenocarcinoma is a challenging disease to treat with significant unmet needs. Initial therapy replicates therapy for metastatic colorectal adenocarcinoma and may include FOLFOX, FOLFIRI or FOLFOXIRI potentially combined with bevacizumab. Salvage therapy may include 1) trials (gui...
Can CM577 regimen of adjuvant nivolumab s/p neoadjuvant chemoRT with residual disease following surgery be extrapolated to patients with R1 resection unable to undergo re-resection?
This is an excellent question and, of course, one for which there are no data. So, unburdened by data, I'm free to offer my personal opinion. I think all of us would value other comments and responses to this question as well.I think that this question also applies to those patients who achieve a cl...
How does use of adjuvant nivolumab impact your subsequent use of immunotherapy + chemo in a PDL1+ GEJ cancer with metastatic relapse?
This is an extremely important, and practical question, which, unfortunately, we have very limited data on. Clearly, more study is needed here so that we can develop more carefully tailored therapies for our patients. However, for now, my approach is primarily based on the timing of metastatic disea...
How would you manage a patient with history of follicular lymphoma treated with Bendamustine-Rituximab who now has a new FDG avid lesion that is biopsy proven CD30 positive CD20 negative DLBCL?
Certainly an unusual and challenging situation, and one that raises multiple questions. How long ago was the rituximab - is the CD20- status "true" or might it be a false-negative in the presence of blocking antibodies? Is it really totally negative or rare/dim?But taking at face value that the dise...
Is there experience/reports of using voxelotor in sickle cell patients who are Jehovah Witnesses with few crises but who have fatigue and/or dyspnea?
I would not hesitate to use voxelotor in most patients with sickle cell anemia, including Jehovah's Witnesses, if they have not responded to hydroxyurea with near cessation of acute vasoocclusive events and have continued hemolytic anemia. Voxelotor usually reduces hemolysis that results in an incre...