Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Should GnRH agonist therapy be continued beyond 5 years (along with an aromatase inhibitor) in young pre-menopausal women with high risk breast cancer who continue to have ovarian function at 5 years of endocrine treatment?
My response of 'No' assumes that the patient has been on OFS (with either tamoxifen or an AI) for her first 5 years of adjuvant endocrine therapy. We have no data on benefit of OFS beyond 5 years, the benefit on continuing AI beyond 5 years is very modest, especially in regards distant recurrence, w...
Do you recommend bevacizumab in platinum sensitive recurrences of epithelial ovarian cancer?
Bevacizumab was approved for use in combination with chemotherapy followed by continued bevacizumab maintenance in patients with platinum-sensitive recurrent ovarian cancer in December 2016. This approval was based on the findings of 2 studies, GOG-213 and the OCEANS trial. Both trials demonstrated ...
What is your alternative first line approach to follicular lymphoma that requires treatment if initial treatment with BR leads to significant neutropenia despite G-CSF?
My approach depends on the number of cycles the patient has received and the response to those cycles, along with reason for neutropenia (all treatment based vs disease related). If a patient has significant neutropenia from treatment/therapy, my initial approach would be to add GCSF for the next cy...
How are you treating patients who progress while on durvalumab after definitive chemoradiation for stage III NSCLC?
I usually recommend a bx to confirm the presence of metastatic disease. I ensure that all other biomarker information is available, including PD-L1 is obtained, of not performed already. In the absence of actionable/ targetable mutations, I offer patients a KN189/KN407 type regimen at the time of pr...
How do you discuss avoiding pregnancy in the premenopausal patient while on chemotherapy and/or endocrine therapy?
We have an active discussion in any PRE-menopausal patient, which is documented in the chart along with their method of contraception. A pregnancy test is obtained prior to the start of chemotherapy, but not routinely repeated unless there is reason (e.g. patient reports not using an contraception, ...
What is your approach to metastatic non-clear cell RCC?
A majority of the clinical trials conducted in renal cell carcinoma are conducted exclusively in clear cell carcinoma. We know from retrospective analyses (De Velasco et al Clin GU Cancer 2017) that these patients have a worse prognosis with traditional therapy. Small randomized trials dedicated exc...
Do you treat atypical carcinoid of the lung with N2 or N3 nodal involvement with definitive concurrent chemoradiation?
I agree that these are very difficult cases due to the lack of data for either radiation or chemotherapy responsiveness in bronchopulmonary NETs. When possible we try to offer surgery. For patients with resectable N2 disease, I would recommend surgery and then consider adjuvant chemotherapy for atyp...
Would you use cetuximab or panitumumab to treat a patient with stage IV colon cancer who is KRAS/NRAS wild-type but has a PIK3CA mutation in tumor tissue?
Would you give additional chemotherapy to women with stage III HER2+ breast cancer who have a grossly suboptimal response to neoadjuvant TCHP x6?
It really would depend on the hormone receptor status of the patient. If a patient was ER positive, one may not expect a pCR from TCHP, and they may benefit from Neratinib extended therapy based on the ExteNET trial. The HR was 0.6 for IDFS for the patients that had tumors that were hormone receptor...
What chemotherapy regimen would you recommend for high risk ER+/Her2- LN negative breast cancer with high genomic risk disease?
For the patient described, with high genomic risk but otherwise good-risk features (ER positive, HER2 negative, node negative) I would recommend TC x 4 cycles as reported in Jones et al (JCO 2009, 27:1177). The use of anthracycline plus taxane adds benefit overall as shown in the ABC trials, but for...