Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How do you treat a composite NHL of various subtypes?
There is no single answer here because composite lymphomas are highly varied and variable. The general principles here are to treat the component disease most in need of treatment, as best you can, and not to sacrifice curative intent for an aggressive curable component. For the case of composite ag...
Would you hold off on whole brain radiotherapy for a patient with metastatic NSCLC and multiple asymptomatic brain metastases and will be starting immunotherapy?
This is a very controversial area right now (as are most MedNet queries!). Given the data available and the opinion pieces by thought leaders right now on immunotherapy results in melanoma brain metastases, it would be very reasonable to hold off on WBRT for patients with asymptomatic melanoma brain...
What is your preferred maintenance therapy in young, fit patients with de novo plasma cell leukemia who achieve complete response after autologous stem cell transplantation?
Plasma cell leukemia is routinely excluded from post-transplant maintenance studies, so we cannot look to any of the randomized maintenance studies performed over the past decade. I would consider plasma cell leukemia to fit into the category of ultra-high risk myeloma, and would use lenalidomide pl...
Is there a preferred sequence of therapy in renal cell carcinoma?
For many years, sunitinib and pazopanib have been the standard first line therapy for metastatic clear cell RCC. A new treatment paradigm is now evolving. Longer overall survival and higher response rate of nivolumab/ipilumimab and pembrolizumab/axitinib combinations vs. sunitinib were demonstrated ...
How would you approach a patient with Li Fraumeni syndrome and a mucinous anal adenocarcinoma with inguinal node metastases?
The safe dose of radiation in this setting is not known. There is not much published about it in Li Fraumeni patients. Mucinous adenocarcinoma suggests low rectal cancer as opposed to adeno of the anal canal. Either way, we would treat this like rectal cancer. At our institution we would use nonoper...
Would you retreat a patient with docetaxel for metastatic castrate resistant prostate cancer if treated in hormone sensitive setting (metastatic disease) with good response three years ago but now has CRPC and has progressed on abiraterone?
If the patient had a favorable response (presumably in setting of metastatic hormone sensitive prostate cancer), and it was well tolerated w/o evidence of chronic toxicities such as neuropathy I would definitely use docetaxel again. There is historic evidence for a docetaxel holiday in the metastati...
How do you approach a patient who responded to first line osimertinib but develop an isolated progressing lesion that retains sensitizing EGFR mutation but develops MET amplification?
Radiate single site and continue OSI. Repeat liquid biopsy at next progression.
How would you approach a post-menopausal woman who now wishes to start adjuvant endocrine therapy more than 3 years since surgery?
The short answer is yes. You start endocrine therapy even if it is late. It is important to remember that events in this disease occur later and very few events occur in the first few years anyway. Like starting any treatment, it is a good idea to weigh risk of recurrence and value of treatment, es...
How do you approach non-surgical patients with GIST who are intolerant to imatinib 400 mg daily and unlikely to tolerate other TKIs?
Great question! I usually try splitting it first: 200 in the am and 200 in the pm. I also aggressively manage side effects. If still a problem, I may have to reduce the dose.
How do you approach patients with Stage IIIB/C NSCLC with ipsilateral supraclavicular (N3) disease?
Concurrent CT/RT followed by durva if no PD or pneumonitis.