Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Is there a role for incorporating local therapy into the management of oligometastatic EGFR-mutant NSCLC with curative intent?
I don’t think there is such a thing as curative intent oligometastatic therapy. That said, consolidative SBRT to 1-3 safe lesions for osimertinib responders seems very reasonable
How would you treat isolated axillary recurrence of a previously node negative ER/PR+, HER2- breast cancer after prior neoadjuvant chemotherapy, lumpectomy/adjuvant RT, and adjuvant AI?
The problem of isolated local or regional recurrence has been a vexing one for years. There have been multiple attempts to complete a randomized trial with sufficient numbers to draw conclusions and none have succeeded. I was Principal Investigator for one such Intergroup trial in the 1980's closed ...
With new data now available for use of brentuximab in ALK positive, CD30 anaplastic large cell lymphoma, what is your first line regimen?
I would say in the light of ECHLON-II data with a PFS and OS advantage specifically in ALCL and Advanced stage ALK positive disease Brentuximab-CHP would be the most beneficial option and standard of care.
How do you decide between enrolling an oligometastatic NSCLC patient on LU-002 versus treating them with SBRT off trial?
On behalf of @Dr. First Last, MD, PhD and @Dr. First Last, MDThis question is very important and goes towards the question of equipoise from the perspective of the physician and patient for enrollment on NRG-LU002, accounting for recent data from Gomez et al and Palma et al presented at ASTRO 2018. ...
Would you consider hormonal therapy and no RT in an elderly pt who developed a contralateral early stage, ER+ breast cancer while on Tamoxifen for previous breast cancer?
I agree with @Dr. First Last. I view these cases as more aggressive as the malignancy developed while on hormonal therapy. Of course each case depends on the individual performance status and goals of the patient.
Would you consider adjuvant capecitabine as well as trastuzumab in a patient with ER/PR negative, HER2 positive breast cancer treated with neoadjuvant chemotherapy /trastuzumab/pertuzumab who has residual disease on path?
Treatment with adjuvant TDM1 would be the recommended approach based on the KATHERINE data.
How do you decide for which high-risk post-menopausal women to extend adjuvant endocrine therapy after completing 5 years?
Ever since the MA.17R data was presented by Paul Goss at the ASCO plenary session in 2016 and its simultaneous publication in NEJM, extended aromatase inhibitor therapy has been a topic of great interest. This study did show an nearly 4% absolute benefit for the longer duration as far as DFS was con...
Will you offer adjuvant T-DM1 for patients with HER2+ breast cancer who have residual invasive disease following neoadjuvant therapy?
The KATHERINE trial was presented at this years San Antonio Breast Cancer Symposium and published on line in the NEJM Dec 5. The trial was a phase III randomized trial for women who residual disease post-neoadjuvant HER2-targeted chemotherapy regimens. The randomization was to 1:1 with either trastu...
Will you offer Ibrutinib and Rituximab for untreated patients with CLL without a 17p deletion?
The ECOG 1912 study presented at ASH this week showed better OS and PFS in younger patients with ibrutinib, which was great news. I used to use FCR in these patients as it was said to have a higher rate of MRD but potentially dangerous myelo- and immunotoxicity and of course there's concerning issue...
What is your preferred first-line therapy for a patient with standard risk multiple myeloma?
Tough question. Let's do the easy ones first. The low risk (R-ISS 1) fit patient could be treated any number of ways with Bortezomib+Lenalidomide+Dexamethasone (RVd), Carfilzomib+Lenalidomide+Dexamethasone (KRd), or Daratumumab+Lenalidomide+Dexamethasone (Dara-Rd). Bortezomib can lead to neuropathy...