Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
When would you consider neratinib in a patient with locally advanced HR positive, Her2 positive breast cancer who received one year of trastuzumab and pertuzumab?
There is no data on adjuvant neratinib following one year of trastuzumab and pertuzumab. However, as the added benefit of pertuzumab to herceptin in HR pos HER2 pos is minimum in the adjuvant setting, I would consider neratinib in high risk patients, for example being node positive.
Do you ever consider hormone replacement therapy in a woman who is suffering from early menopause that has been likely cured of her breast cancer and undergone bilateral mastectomies?
A short period of HRT is OK The fact she has or has not had a bilateral mastectomy does not change my answer
Would you offer Durvalumab as consolidation therapy to a patient with stage III NSCLC but had local recurrence treated with definitive SBRT?
This very relevant and highly challenging question brings to mind Osler’s quote: "Medicine is a science of uncertainty and an art in probability". How do we apply the data that we have to the individual patient in front of us needing our best counsel? How do we apply the now more mature (see prior...
What is your approach to CMV prophylaxis in the post-allogeneic stem cell transplant setting?
We do not routinely use letermovir but we are looking carefully at this data. We use prophylactic ganciclovir pre transplant and high dose acyclovir post transplant in high risk patients and are reviewing this data as well.
How do you utilize lenalidomide maintenance in non-transplant eligible myeloma?
Maintenance is a standard of care management for both transplant eligible and transplant ineligible, regardless of type of induction regimen. Studies have shown benefit for both groups. Time to progression (PFS) almost twice as long for both groups with maintenance compared to no maintenance. - For ...
For pre-menopausal female patients who present with acute leukemia in need of urgent anti-neoplastic therapy, what is your preferred approach in effort to preserve fertility?
This patient would be a good candidate for ovarian tissue cryopreservation (OTC), since time would be limited to stimulate and retrieve oocytes. One can complete OTC with line placement and other procedures and be able to start chemotherapy the day after OTC. I know not every center has access to OT...
How would you approach distant oligometastatic HPV positive oropharyngeal cancer previously treated with definitive local therapy?
Patients who present with a single focus of disease outside of their local regional disease, technically have stage IVC (i.e. widespread metastatic) disease. Such patients could be offered a palliative course of RT to their locally advanced disease followed by systemic chemotherapy; however, given t...
What chemotherapy regimen do you prefer for postmenopausal women with T1 ER positive tumors with 1 positive LN?
For T1N1M0 ER positive tumors, I first do a Mammaprint. In MINDACT, Mammaprint low risk ER + N+ (up to three nodes) tumors had no improvement in 5 year DDFS (still about 94-95%) with the addition of chemotherapy to endocrine therapy.If the woman had a high risk Mammaprint, I would give AC x 4 follow...
What is the role of targeted therapy in relapsed/refractory ALK+ anaplastic large cell lymphoma?
I recently had an ALCL patient with small cell pathology which, as you know, is a poor prognostic pathology. I asked the same question, and the response from the COG expert, based on the unpublished data from ANHL12P1, was not to add targeted therapy up front but to base the decision on response. I ...
Should atezolizumab be used with chemotherapy in the first line treatment of ES-SCLC?
Yes, as noted by the presenter of the results of IMpower 133 at WCLC, atezolizumab+ etoposide/carboplatin is a new standard of care for front-line therapy of ES-SCLC. This result should be embraced as it represents the first meaningful advance in the initial treatment of SCLC in decades. The reporte...