Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How would you treat a patient with an inflammatory triple negative breast cancer with contraindications to an anthracycline?
No easy answer. We all can agree that we need to achieve the pCR to have the long-term best outcome. The standard regimen for triple negative primary IBC is AC x 4 cycles followed or preceded by paclitaxel weekly x 12 cycles. I am not quite sure why you can not administer anthracycline, but I am goi...
Do you offer durvalumab to patients with stage IIIB NSCLC after chemoradiation if they are also on long term dialysis for ESRD?
Antibodies are generally not dialyzable with conventional methods. Given the cancer diagnosis, these patients are not candidates for transplant in the short term. With a prognosis of advanced stage NSCLC worse than the prognosis arising from ESRD already on long-term dialysis, I will offer the optio...
Would you extrapolate data from PACIFIC trial for unresectable disease to consider consolidation therapy with durvalumab for Stage III NSCLC with single-station N2 disease amenable to lobectomy?
I agree with both answers above. The question about adding durvalumab after chemo-RT and lobectomy continues to come up. I would not extrapolate the data from PACIFIC to this situation. First, its important to point out that its not indicated in this situation - the approval for durvalumab in the US...
What is your approach to asymptomatic patients with progressing lung metastatic adenoid cystic carcinoma originally arising from the trachea?
In my practice, it depends on the disease burden and the rate of progression. If it's very slow, and the disease burden is modest, which is not uncommon, then often the risk of potential side effects can outweigh the potential benefit, given the lack of good data on systemic treatment, especially on...
How would you manage adjuvant therapy in a BRCA1-mutated woman with ER+, Her2 negative breast cancer with residual disease at surgery after neoadjuvant therapy with a taxane-based regimen?
There are several factors to consider in this case. One is whether the patient has received optimum chemotherapy. If there is only minimum residual disease at surgery, I would not recommend additional chemotherapy in the adjuvant setting. On the other hand, if there was significant residual disease ...
What would you use as next line of treatment for a patient with ROS1+ metastatic NSCLC progressing on first line TKI?
The finding that crizotinib was quite active in ROS1 altered cancers (Shaw et al., PMID 25264305 - confirmed in East Asian patients - Wu et al., PMID 29596029) obviously altered the practice of thoracic oncology, and led to the approval of crizotinib in patients with ROS1 translocations. Moreover, t...
What is your preferred third line approach for a patient with refractory small cell lung cancer who has failed second line therapy with nivolumab after recieving first line platinum based therapy ?
I would prefer a clinical trial or perhaps a taxane, but I have added ipilimumab to nivolumab in this situation, despite the lack of data. The results remain to be seen!
What chemotherapy regimen would you give for metastatic adenocarcinoma that arose from teratoma/germ cell tumor?
Teratoma is pluripotential tissue that can de-differentiate along mesodermal, ectodermal or endodermal elements, and this case endodermal to "adenoCA" However, very rare to have late relapse 30 years later. If lesions in same loci as 30 years ago, compelling case for very late relapse. To be honest,...
How would you treat a case of mixed histology NSCLC/SCLC that rapidly progresses following chemoradiation and durvalumab?
In recent weeks, I have had several patients progressing on or immediately after stopping durvalumab following chemoradiation—a frustrating and difficult situation. In the patients I saw (without mixed histology), I discussed clinical trials of post-immune therapy progression. The particular questio...
How do you approach chemotherapy use in patients with locally advanced ER+/HER2 negative patients with cirrhosis and platelets < 100K?
This is fortunately a rare situation encountered in breast cancer patients but in those situations it poses a challenging problem. In general, I look at this as two categories: In patients with compensated cirrhosis (with Child-Pugh score less than 7 and no clinically detectable ascites), the mortal...