Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How would you treat a young female with a recurrent triple negative breast cancer to the contralateral breast?
I would imagine 3 years later in the contralateral breast that this would be a new primary. We would want to treat this as its own separate cancer. I would avoid anthracycline as she has already received this but what specific chemotherapy I would pick depends on the tumor size and lymph node sta...
Would you recommend adjuvant chemoradiation for a resected ampullary adenocarcinoma?
There is no clear cut answer to this question. There is suggestive evidence from retrospective studies that adding radiation therapy to a chemotherapy regimen improves outcomes, but those are retrospective and non-randomized, with all the inherent difficulties in those analyses. The limited randomiz...
Has the recently published SELECT trial of adjuvant erlotinib in early stage EGFR-mutant NSCLC impacted your management of these patients?
The SELECT trial was a well conducted single arm trial of post-operative adjuvant erlotinib in early stage patients with NSCLC bearing an activating EGFR mutation. Compared with historical controls with and without EGFR mutations, the disease free and overall survival were superior. The study establ...
How do you choose between atezolizumab, bevacizumab, carboplatin, paclitaxel (IMpower 150) vs. pembrolizumab plus chemotherapy (KEYNOTE 189) in patients with metastatic NSCLC?
This is a great question. As we are all well aware, the combination of chemotherapy and immunotherapy has become a standard of care for some patients with advanced non-squamous NSCLC. Both the IMPOWER trial published by Socinski et al. in NEJM and the KEYNOTE 189 trial published by Gandhi et al. in ...
How do you treat metastatic renal cell carcinoma with unclassified histology without sarcomatoid features?
There is limited data on optimal treatment of advanced non-clear cell RCC in general, including unclassified RCC. I have summarized the available data that I am aware of: The phase II study ASPEN randomized advanced nccRCC patients, including 20% with unclassified RCC, to sunitinib vs everolimus. Of...
Would you trial a different TKI (vs chemotherapy) if a patient with metastatic EGFRm lung adenocarcinoma developed grade 4 pneumonitis on first line osimertinib?
Presuming patient recovered from grade 4 pneumonitis, there is precedent to switching as reported by clinicians/investigators in Japan wherein EGFR TKI-induced ILD occurs with much greater frequency in this ethnic population compared to the West. As reported by Takeda et al (Japanese Journal of Clin...
What is a preferred regimen for metastatic leiomyosarcoma after failure of doxorubicin/olaratumab and gemcitabine/docetaxel?
What is a preferred regimen for metastatic leiomyosarcoma after failure of doxorubicin/olaratumab and gemcitabine/docetaxel? I would consider treatment with either trabectedin or pazopanib.
How would you manage a patient with esophageal SCC that completed concurrent chemoradiation without definitive surgery with imaging evidence of local progression but biopsies only show focal dysplasia?
What chemotherapy regimen would you recommend to a patient with local regional recurrent ER negative, HER2 positive breast cancer who received TCH more than 5 years ago?
I would treat this patient with chemotherapy and anti Her-2 therapy. Her-2 positive disease has a higher risk of distant recurrence and as long as the primary tumor is >0.5 cm in size, I recommend chemotherapy with anti Her-2 therapy. The type of anti Her-2 therapy and chemotherapy will depend on th...
In transplant-eligible, fit patients with multiple myeloma who have an inadequate response to front-line therapy, what regimen would you choose for second-line?
for transplant eligible patients who you want to get to transplant but have not achieved an adequate response for stem cell collection, there are 3 senarios: 1: if no response at all to front line therapy (VRd) say <PR: would do VDPACE x 2-3 cycles, using the last cycle as chemo mobilization with co...