Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Would you consider age of 70 years as a contraindication (without any other cardiac risks) to use anthracycline in a triple negative breast cancer patient?
As always, it depends. The DFS advantage for anthracycline-based regimens over TCx6 in the ABC trials (J Clin Oncol 35:2647, 2017) was for patients with lymph node involvement, so they were at high risk. In a fit woman who is age 70 or older, the benefits of including the anthracycline likely outwei...
Why do we give four cycles of TC as adjuvant therapy when some of the clinical trials administered six cycles?
There are three trials I use to think about this issue: USOR 9735 (TC x 4 vs AC x 4, Jones et al JCO 2009; 27: 1177-1183), ECOG 1199 (AC x 4 with paclitaxel qw x 12, vs taxol q3w x 4, vs docetaxel qw x 12, vs docetaxel q3w x 4, Sparano et al JCO 2015; 33: 2353-2360) and the ABC analysis (TC x 6 vs T...
How would you approach a patient who progressed on immunotherapy for merkel cell carcinoma?
This is an excellent question in a rare disease where we have clearly seen the use of immunotherapy leap to the forefront of management. Based on the Javelin II (previously treated patients) data, the FDA approved the use of Avelumab for patients with advanced MCC regardless of prior therapy in May ...
What adjuvant chemotherapy is preferred in primary ovarian mucinous adenocarcinoma of intestinal type?
Mucinous ovarian cancers are rare (3-4%) and are distinct from high grade serous ovarian cancers. Many of our trials for adjuvant chemotherapy in ovarian cancer only included small percentages of patients with mucinous histology (typically less than 5% entered in trials). While serous tumors tend to...
How would you treat a younger patient with relapsed mantle cell lymphoma after treatment with hyperCVAD?
In front line therapy for MCL patients, induction followed by ASCT should be the standard of care followed by rituximab maintenance and follow up for MRD.In relapsed MCL, after anthracycline and cytrabine containing therapy, BTK inhibitors appear to be the most affective agents.Results of a pooled a...
Do you offer consolidative thoracic radiation for oligometastatic NSCLC following upfront immunotherapy?
Yes, I do offer consolidation in patients with oligometastatic lung cancer after immunotherapy. Like @Dr. First Last, often these patients are referred to me at "oligoprogression," when one lesion progresses (often the primary or largest site), but most minor lesions appear to be under control. The ...
Is there a role for temozolomide in patients with Stage IV NSCLC with leptomeningeal disease who have progressed on first line chemo-immunotherapy?
I've tried it and have never been impressed with it. The only treatments that I've ever seen convincingly work for LMD in NSCLC is in patients with actionable mutations treated with brain-penetrating TKIs.
What is your general approach to post-allogeneic HSCT maintenance therapy for AML?
I use midostaurin starting 60-90 days after allogeneic transplant continued till 1 yr post transplant for patients with Flt-3 mutations. Some of my colleagues prefer sorafenib for post transplant maintenance in this setting. I have not yet started using IDH inhibitors post allogeneic transplant. HMA...
Is there any clinical benefit in giving Tamoxifen in a pre-menopausal woman with early stage breast cancer who initially refused adjuvant hormone therapy for years?
I would think that there would be clinical benefit to giving tamoxifen in a delayed fashion to a patient who initially refused adjuvant therapy, but this is not exactly a "data-driven" reply given that we do not have trials analyzing this particular situation.Data indicates that recurrence risk of h...
How do you counsel a young woman carrying a BRCA 1 or 2 mutation and history of breast cancer who desires pregnancy?
Pregnancy subsequent to breast cancer does not worsen the prognosis. If a young BRCA carrier desires to become pregnant she should be supported. Points to emphasize: 1) the rates of ovarian cancer don't begin to rise until after 35 years; 2) she can be screened by breast ultrasound during pregnancy;...