Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
What adjuvant therapy would you recommend for a T3N0, grade 3, undifferentiated sarcoma of the mandible with positive margins that is not amenable to re-resection?
Not much in the mandible is unresectable. I would get the patient a second surgical opinion with an experienced ENT surgical oncologist. Regardless of use of RT, R0 margins are necessary for optimal local control in STS so would want to evaluate for any possibility of re-resection. (A nuance to this...
How would use of adjuvant pembrolizumab after nephrectomy for ccRCC impact your treatment choice for metastatic recurrence?
I think treatment selection after recurrence/metastases will depend on the timing after adjuvant pembrolizumab has been completed. If it's about 9 months or more, I think re-challenge with pure IO/IO combination is fair, especially if a patient tolerated pembrolizumab well. If it's within 3-6 months...
In what setting would you omit neoadjuvant radiation in favor of neoadjuvant chemotherapy alone for a T3N0 upper rectal adenocarcinoma?
The benefit of radiation for clinically staged T3N0 upper rectal cancers is unclear. Overall, the benefits of neoadjuvant radiation seem to be for lower rectal cancers. The main concern, in this case, is that clinical staging may underestimate pathological staging, as benefit from (neo)adjuvant radi...
What is your strategy to help prevent paclitaxel-related neuropathy?
There are no proven strategies for prevention of CIPN and the use of these supplements is not recommended. Some supplements such as acetyl carnitine can actually worsen neuropathy outcomes and some supplements such as B12, vitamin C, and others may negatively interact with chemotherapy and worsen di...
Would you offer adjuvant chemoRT to a patient who underwent neck dissection for a T0N1M0, p16+ head and neck squamous cell carcinoma?
Yes. At least the RT. Chemo would depend on the extent of neck disease. Multiple nodes and/or level 4, add chemo.
At what platelet count would you feel comfortable dosing aspirin 81 mg for coronary artery disease in a patient with ITP?
In a patient with ITP, I would certainly feel comfortable dosing aspirin 81mg daily at a platelet of 50,000 or greater. As you know, the risk of bleeding in a patient with ITP is less than would be expected at a particular platelet count because the circulating platelets in ITP are young and large. ...
What is your preferred anticoagulant for acute portal vein thrombosis?
The most common reason for portal vein thrombosis is underlying portal hypertension from cirrhosis. Thus, treatment choice is limited by the underlying liver disease. If they have liver disease with prolonged baseline PT, coumadin should not be used. Likewise, if they have liver disease, I don't fee...
How do you approach management of newly diagnosed locally advanced NSCLC in patients who are intubated for respiratory failure due to their disease burden?
There are a few other approaches that can sometimes help: Interventional pulmonology can sometimes debulk tumor in the airway and/or place a stent. I've had some success with intrabronchial brachytherapy as well. I've had more success with 1-3 relatively large radiation fractions (4-6Gy). However,...
Are there known biomarkers predictive of response or resistance to sacituzumab govitecan which should be incorporated into treatment decisions for metastatic TNBC?
In the ASCENT trial, we evaluate the association between Trop-2 expression and clinical outcomes. Overall, the median progression-free survival (PFS) was 6.9, 5.6, and 2.7 months for high, medium, and low Trop-2 scores, respectively with SG compared with 2.5, 2.2, and 1.6 months with standard chemot...
For a young patient who had a prior pCR to neoadjuvant therapy, would you consider systemic therapy after local resection and radiation of an isolated brain metastatic recurrence of triple negative breast cancer?
We have had prior discussions about this clinical scenario and there was a range of opinions due to the lack of definitive data in this space. Many felt that if a patient was NED after the resection that they could be observed as some patients can remain so with no further systemic therapy. I think ...