Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Would you consider a PARP inhibitor in a patient who harbors a germline BRCA mutation who has metastatic HER2 negative gastric cancer?
Would you consider cystectomy in a patient who acheived radiologic and cystoscopic CR from chemo-radiation for oligometastatic urothelial carcinoma originating in the bladder if remains disease free > 6 months?
For this patient, I would currently recommend 4-6 cycles of cisplatin based chemotherapy followed by avelumab switch maintenance therapy. I would strongly consider radiation or chemoradiation after the combination chemo directed at the bladder and lymph node, followed soon after by avelumab. I think...
When do you have a patient proceed to surgery for breast CA after completion of neoadjuvant chemotherapy if they developed a line-associated upper extremity DVT/VTE after completing chemo?
If it is port-associated thrombosis you can anti-coagulate using a short-acting anti-coagulant like therapeutic doses Lovenox (half-life 4.5 hrs.), and stop it 12-24 hours prior to surgery and re-start 5-6 days later depending on the surgeon's individual preference. If possible, I would wait 3-4 pri...
In patients with metastatic NSCLC with EGFR mutation currently being treated with osimertinib, would you consider increasing dose from 80mg to 160mg at the time of progression?
For systemic progression would not increase dose. If PD only brain mets and asymptomatic would consider raising dose and continuing. If brain mets only were symptomatic would do SBRT and consider increasing dose.
What is your preferred sequence of chemotherapy regimens after patients with metastatic endometrial cancer develop resistance to carboplatin + paclitaxel?
This is a bit of an 'it depends' answer. If the patient has large volume disease or is highly symptomatic I will generally switch to liposomal doxorubicin. However, if the patient has more minimal disease, disease that is not imminently dangerous (nodal disease, pulmonary nodules) I will use endocri...
How long do you treat recurrent classical Hodgkin lymphoma with brentuximab/nivolumab if the patient does not want to proceed to BMT?
The phase 1/2 study of BV/nivolumab combination aimed to maximize response with a goal to proceed with autologous SCT. In the trial protocol, patients would receive 4 cycles of therapy (Blood 2018).If a patient changed their mind and does not want autologous SCT, then I would drop BV (assuming they ...
In what situations, if any, would you treat locally advanced (non metastatic) anal cancer with induction chemotherapy followed by chemoRT rather than chemo/RT by itself?
Hard to know. I would offer that it is a rare event for me to consider induction chemotherapy prior to chemoradiotherapy at this point. Part of it stems from an honest lack of faith in chemotherapy relative to the effectiveness of radiotherapy/chemoradiotherapy, which has complete response rates in ...
Are there any types of sarcomas that you use induction and/or concurrent chemotherapy with radiation prior to surgery?
Neoadjuvant chemotherapy is controversial in extremity/trunk STS.Generally speaking, grade 2/3 tumors that are ≥5 cm are at high-risk for distant recurrence despite ~90% local control. For these patients, you can consider neoadjuvant chemoRT. When using neoadjuvant chemoRT, the more common approach ...
Would you consider giving tamoxifen prophylaxis to young women with pathogenic BRCA2 muations who are <35 years old?
There is some evidence to support use of tamoxifen in non affected carriers. Secondary analyses of 288 patients who developed cancer in NSABP P-1 trial suggested a 62% risk reduction in incidence of breast cancers in known gBRCA 2 carriers,no benefit in gBRCA 1. This data is limited by fairly low nu...
For inpatient treatment of lymphoma and ALL, can rituximab be delayed?
Although I am not aware of published data on this issue, at least for patient receiving DA-R-EPOCH, I have learned that it is common practice to delay the day 1 rituximab because of the reimbursement issue you refer to. I don't think the effect of this has been studies systematically, but i'm not aw...