Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How do you chose between 4 or 6 cycles of chemotherapy in patients with small cell lung cancer?
Very good question made a bit more straightforward with the publication in NEJM of IMpower 133 for extensive stage disease and recently added to NCCN guidelines as a category 1, preferred first line therapy in ES-SCLC. I typically follow the four cycles as used in IMpower 133 for patients with exten...
How do you approach metastatic colon cancer that has been refractory to multiple lines of systemic therapy though maintaining an adequate PS for additional treatment?
Unfortunately, if the patient has seen all standard therapies, including third/fourth line TAS-102 and regorafenib, then the only option is clinical trials. Molecular profiling could also reveal less common (and less "standard" tested) molecular abnormalities that could offer more options, such as H...
How do you approach fit patients with quickly relapsed Hodgkin lymphoma (disease-free interval less than or equal to one year) after 6 cycles of ABVD and radiation therapy?
As of this point in 2018 such patients are curable only with high-dose chemotherapy with stem cell transplant and then only if they are in chemosensitive relapse. Accordingly, I would have the transplanters see the patient at once and follow their recommendation regarding the pre-transplant regimen ...
How do you approach incidentally diagnosed mantle cell lymphoma found on a routine screening colonoscopy?
Stage IE MCL would be very rare; this is probably disseminated disease with extra nodal GI involvement which is seen in the majority of such patients. I would treat as disseminated disease, PS and comorbidity permitting per NCCN guidelines.
Are there data for treating patients with metastatic NSCLC with BRAF nonV600E mutations with BRAF and MEK inhibitors?
There is limited data on the efficacy of RAF and MEK inhibitors in the treatment of patients with lung adenocarcinoma that harbor a BRAF non-V600E mutation. Published series of small numbers of patients suggest that Dabrafenib, Vemurafenib, and Trametinib are less active in this patient population c...
How would you treat an elderly fit patient with stage IE DLBCL (single skin lesion)?
Is this a primary cutaneous large B-cell lymphoma, leg type? I suspect so. This is a rare and aggressive disease. I would carefully stage the patient ( to include bone marrow ) and treat as per any localised DLBCL with 3-4 cycles R-CHOP and XRT. Even with this regimen 50% of patients relapse so I'd ...
What systemic therapy option do you use for metastatic, anal squamous cancer with progression following FOLFOX and subsequent nivolumab?
If a clinical trial is not available and residual neuropathy from oxaliplatin is not an issue, I would favor carboplatin/paclitaxel.
Should olaparib maintenance therapy be recommended in patients with BRCA-positive, advanced ovarian cancer after first line platinum-based chemotherapy?
While the results of the SOLO-1 trial are initially impressive, we need to wait for the survival data and the results of the other 2 European trials (Paola-1 and ENGOT). Definitively a field of research to keep an eye on. Today, probably premature. On a case by case basis, might be acceptable, but n...
What adjuvant systemic therapy do you recommend for a pre-menopausal patient with a localized recurrence of ER+PR+HER2- invasive ductal carcinoma while on adjuvant ovarian suppression with an aromatase inhibitor?
This is a difficult clinical scenario. First, I would determine whether she was compliant with her medication. With the assumption that she was compliant, I would say that there is a paucity of data in this setting. The final analysis of the CALOR trial demonstrated that, after a median of 9 years, ...
Would you offer upfront osimertinib rather than whole brain irradiation for a patient with stage IV, EGFR exon 19 mutated lung adenocarcinoma who presents with leptomeningeal metastases?
As always a challenging situation is raised by a question in this forum. Clearly more clinical information is relevant. Not clear as to what "The patient 'presented' with leptomeningeal metastases" means. In many patients, asymptomatic leptomeningeal metastases are detected on MRI scans of the brain...