Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
What alternative adjuvant therapy do you recommend to an imatinib intolerant patient with high-risk GIST?
In patients who develop a VTE on palbociclib, do you discontinue therapy or continue as long as the patient is receiving adequate anticoagulation therapy?
Thromboembolic events were seen in Paloma studies but the frequency was quite low and comparable with what would be expected to be associated with the presence of metastatic disease. Initially, there seemed to be a small increase in the patients taking palbociclib compared to the control arms. In th...
How much variability can you see in levels of ER/PR expression between the primary tumor and a metastasis to make you reconsider if it's a second primary?
Expression of estrogen, progesterone receptors can vary over time and between primary and metastatic sites in approximately 10-15% of cases based on literature. It can also be affected by technical aspects such as cold ischemia time, negative/positive controls used and pathologist interpretation of ...
Would you recommend adjuvant chemoradiation for T1N0 gastric adenocarcinoma status post R0 resection but no D2 lymph node dissection?
I would not recommend adjuvant chemoradiation for a patient with an R0 resection for a T1N0 gastric adenocarcinoma even though a D2 dissection was not performed. If the patient had high risk factors, adjuvant chemotherapy may be appropriate in view of distant metastasis rates of ~ 30% with T1-2N0 le...
Do you offer adjuvant chemoimmunotherapy after IFRT for Stage I to II low grade follicular lymphoma?
I do not. Absent overall survival benefit, which is not seen or reported, this strategy overtreats the subset of patients who are cured with RT alone, and prematurely exposes the other group to the toxicity of chemotherapy.
Would you consider using an anthracycline-based regimen again for a breast cancer patient who previously received doxorubicin 10 years prior?
I would not re-treat with an anthracycline for several reasons. She is at higher risk of heart failure (HF) by virtue of the prior exposure to anthracyclines, and you couldn't get in standard course of anthracyclines because of quickly exceeding the 450 mg/m2 limit where the risks HF increase dramat...
When do you recommend adjuvant chemotherapy for an incidentally detected, low grade appendiceal mucinous neoplasm s/p appendectomy?
Low-grade appendiceal mucinous neoplasm (LAMN) is one common type of neoplastic mucinous appendiceal lesions and it is a true neoplasm that produces abundant mucin but does not have infiltrative epithelial invasion of the appendiceal wall (pushing but not infiltrating). LAMN can be discovered incide...
Do you routinely offer aspirin as an adjunct with adjuvant therapy in colorectal cancer?
Agree with Axel. I do discuss ASA to adjuvant and metastatic patients. Vitamin D, tree nuts, gut health with probiotic sources, exercise, mediterranean diet as some lifestyle modifications.
Would you re-challenge patients with an EGFR TKI beyond progression if repeated biopsies show redemostration of a sensitizing mutation (exon 19 deletion) and no other resistance mechanisms?
In a patient who has progressed after initial TKI based therapy and who lack a specific resistance mechanism (for example, a T790M in patients treated with first line TKI), my typical "next line" is chemotherapy (+/- immunotherapy - the IMPower 150 study showed the same hazard ratio for patients wit...
Do you offer adjuvant chemotherapy and/or radiotherapy for patients with resected atypical carcinoid of the lung with positive mediastinal lymph nodes (T3N2M0)?
I usually offer 4 cycles of adjuvant therapy with cisplatin plus etoposide for patients with surgically resected T3N2 atypical carcinoid tumor. Atypical carcinoid have intermediate chemosensitivity between typical carcinoid tumors and small cell carcinomas. I do not offer adjuvant therapy for typica...