Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How do you approach front line treatment for TP53 mutated mantle cell lymphoma?
For patients with TP53 mutations based on the information presented by Eskelund et al. and previous experience. Given the knowledge that the mutation is a dominant negative which eliminates and functional activity of the tumor suppressor it stands to reason that an durable response with chemotherapy...
How would you treat someone with unknown primary metastatic SMARCA4 deficient tumor (high-grade tumor with rhabdoid morphology)?
Ponatinib might be useful. You might also see if a clinical trial is available.http://clincancerres.aacrjournals.org/content/24/8/1932
In a patient with Waldenstrom's macroglobulinemia doing well and feeling better on ibrutinib & rituximab, but with a rising IgM, do you switch treatment or continue?
A lot depends on the pace of increase of the IgM and the line of therapy. If the pace is rapid, I would think about changing therapy. If the pace of increase is small and the patient is asymptomatic, you could continue a little longer. If planning to changing therapy, it may be reasonable to restage...
Is it safe to continue/re-challenge oxaliplatin in patients with oxaliplatin-induced hepatic sinusoidal injury and splenomegaly?
Typically, if there is documented hepatic injury, I will not revisit oxaliplatin as continued therapy will result in continued injury that may limit future therapeutic options. Given that many GI oncology patients will receive multiple agents that are metabolized through the liver and/or have hepati...
Do you routinely order double-hit assessment in cutaneous DLBCL?
There are certainly reported cases of primary cutaneous DLBCL that harbor double-hit mutations. Guidelines do not distinguish the workup of cutaneous DLBCL from other sites, and if a skin DLBCL were to be of germinal center immunophenotype with IHC expression of myc and bcl2 and/or bcl6, FISH would ...
Are you categorically using lenvatinib over sorafenib for unresectable HCC in the absence of contraindications?
I have done that is recent patients, yes. I am doing it because "on paper" I see better PFS and better ORR, of course in addition to the non-inferiority when compared to sorafenib in the randomized trial that is now published. However, I am building experience with respect to tolerance in my particu...
Would you offer a mid-treatment transition from transtuzumab to TDM-1 for a patient already on 1 year of adjuvant trastuzumab who met criteria for adjuvant TDM-1 based on the KATHERINE trial?
The question is if the patient is er positive or negative. Most patients with residual disease are ER-positive or HER-2 positive. If the patient was ER-positive I would discuss switching vs. neratinib and go through the pros and cons of both.
Would you recommended adjuvant endocrine therapy for a high grade DCIS, ER negative, but PR positive that has underwent lumpectomy and adjuvant radiation?
I would not recommend adjuvant endocrine therapy to a patient with high grade DCIS that was ER-negative and PR-positive. Studies such as NSABP B-23 failed to demonstrate a benefit to the addition of tamoxifen to chemotherapy in patients with ER-negative invasive cancers, which has been confirmed on ...
Would you resume durvalumab after several month hiatus due to IO unrelated medical comorbidities that has since resolved?
This is a challenging question and it is hard to know what the right answer is. If the patient's ECOG PS is good, Durvalumab was well tolerated for the most part, and the IO unrelated medical co-morbidities are now under control, I would consider re-initiation of Durvalumab. I would balance risk and...
Do you offer consolidation thoracic radiation after atezolizumab, carboplatin, and etoposide for extensive stage small cell lung cancer?
I have not had the opportunity to treat a patient yet with carboplatin plus etoposide plus atezolizumab. This regimen is not yet FDA approved (as of 2/18/19) to treat patients with extensive stage small cell lung cancer. However, when it becomes FDA approved, I will plan on offering this regimen to ...