Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How do you treat a gastric plasmacytoma which is not amenable to radiation?
This is a very difficult case. Plasmacytomas are very responsive to radiation. you need to determine reason for not doing radiation: is it location, active bleeding, Perforation? Location should not be a big problem for Radiation oncologist. they can use precision tools now to avoid other structures...
Do you include gemtuzumab ozogamicin for any of your newly diagnosed AML patients who are candidates for 7+3 induction chemotherapy?
Yes, I regularly add gemtuzumab ozogamicin (3 mg/m2 IV days 1, 4 and 7) to 7+3 (daunorubicin dose should be 60 mg/m2 IV days 1-3) in newly diagnosed AML in the following patient groups based on the ALFA-0701 data (Castaigne, Lancet 2012): 1) Favorable/Intermediate-risk cytogenetics- subset analyses ...
What is optimal timing or sequencing of therapy for patients with synchronous locally advanced triple negative breast cancer and ovarian cancer with peritoneal carcinomatosis?
Because delays in surgical healing can affect initiation of chemotherapy in ovarian cancer, I would consider neoadjuvant therapy for both the ovarian and breast cancer. Alternatively, one could do debunking surgery and then chemotherapy. I would recommend carboplatin q 3 weeks with taxol weekly x 6 ...
Do you offer adjuvant chemotherapy or abiraterone for patients with high and very high risk prostate cancer with still detectable PSA after radical prostatectomy and lymph node dissection?
I will recommend reimaging outside conventional CT and bone scans. The goal of imaging is to rule out metastatic disease and (hopefully) identify localized residual disease in prostatectomy bed or pelvic LN and consider early salvage RT. Fluciclovine PET is now commercially available and also PSMA P...
Do you recommend switching from chemotherapy to AI+CDK4/6 inhibitor after resolution of visceral crisis in a patient with HR+, HER2- metastatic breast cancer?
In treating metastatic breast cancer, the answer is always "it depends". After all, the goal of treatment is to keep the person in as good shape as possible for as long as possible, which is hopefully on their feet and active instead of suffering from side effects of the cancer (as in visceral crisi...
What would be your approach to a patient with a PIK3CA mutation after progressing on multiple lines of chemotherapy, immunotherapy and PARPi for gBRCA mutated metastatic TNBC?
Would recommend the patient go on a clinical trial of inhibitors against PI3K or AR. Mutations in PIK3CA occurs in approximately 7-9% in TNBC. AR pos TNBC has a higher likelihood of PIK3CA mutation. In the LOTUS trial, the addition of ipatasertib (AKT inhibitor) to paclitaxel improved PFS in patient...
What is your preferred first line therapy for ROS-1 rearranged metastatic NSCLC for patients presenting with CNS metastases?
The recognition of ROS1 as a distinct actionable translocation in NSCLC, and approval of crizotinib in 2016 based upon an expansion cohort of the original phase I study of crizotinib (N Engl J Med. 2014 Nov 20;371(21):1963-71) was an important step. Unfortunately, the limitations of crizotinib in AL...
For elderly women with good PS, when would you omit adjuvant anthracycline for early stage HR+,HER2- breast cancer with a high Oncotype Dx score?
I seldom recommend the use of an anthracycline in older patients with early stage HR+/HER- breast cancer, even when a high Oncotype score suggests that the patient would benefit from adjuvant chemotherapy. In the ABC combined analysis, patients with node negative HR+/HER2- cancers actually did worse...
Has the role of radium-223 changed in the treatment of prostate cancer given the availability of newer anti-androgen medications to treat metastatic prostate cancer?
Radium-223 remains a valuable palliative therapy for men with symptomatic bone metastatic prostate cancer. As we utilize abi/enza/daro/apa with ADT earlier in the mHSPC or M0 CRPC settings, the number of available and effective treatments in the mCRPC diminish. I do not recommend radium-223 with abi...
When would you consider adding adjuvant PARP inhibitor in a young gBRCA mutated patient with HR+,HER2- early breast cancer?
At this time, I would only consider this in the setting of a clinical trial, such as OlympiA (NCT02032823), given that this strategy has not yet been proven to improve outcomes in the early stage setting. These agents are very promising in the neoadjuvant setting, as highlighted by a small pilot stu...