Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Do patients with Stage III unresectable NSCLC with lepidic features require a different approach to chemo-radiation?
For limited stage SCLC with curative intent, do you ever substitute carboplatin for cisplatin in concurrent CRT setting?
Based on the COCIS meta-analysis of carboplatin versus cisplatin-based chemotherapy of SCLC which included patients getting radiotherapy for limited-stage disease (Rossi et al, JCO 2012), there was no evident survival advantage with cisplatin overall. In multivariate analysis, there appears to be tr...
Is there any role for "adjuvant" therapy for completely resected oligometastatic RCC?
The data re: adjuvant therapy for either high risk (bulky or node positive primary renal cell cancer) or completely resected metastatic renal cell cancer (either synchronous or metachronous) remains largely negative. Trials conducted with cytokines or with a variety of multi kinase inhibitors (sunit...
Does the final report and approval of CHECKMATE 227 (ipi/nivo) regimen change your first line recommendations for patients with PDL1 TPS < 1%?
Not at this point. There are many factors that should be considered when treating patients with a PD-L1 < 1%. A recent analysis (page 372, MA25.01) of KEYNOTE 407, 021, and 189 indicated that patients receiving chemotherapy + pembrolizumab had improved survival compared to those receiving chemothera...
How would you approach a young patient with ER+/Her2- bilateral breast cancer with a solitary bone metastasis?
I'm assuming from the question that this is a de novo Stage IV. Assuming a biopsy confirms metastatic breast cancer, I'd start such a patient on the appropriate endocrine therapy. I'd wait on considering loco-regional therapy until there has been a response. This reduces the risk of pursuing loco-re...
How would you manage a postmenopausal female with a history of early stage invasive ductal ER+/HER2- breast cancer s/p mastectomy who has a local recurrence of ER+/Her2 - lobular carcinoma while on letrozole?
I am sure most of us would offer local resection and radiation therapy along with staging work up without consideration for chemotherapy given CALOR data showing no benefit in ER positive cases. The final analysis of CALOR does not support the use of chemotherapy for ER-positive isolated loco-region...
Is there a role at this time for chemo-immunotherapy in the upfront treatment of classic Hodgkin lymphoma?
How would you approach adjuvant therapy for a premenopausal female with HR+, HER2+ breast cancer with N1mic disease?
This is a difficult case; I see why someone posed the question. I'd want to know more information: - how old is this premenopausal women? - what is the grade of the cancer?- how many lymph nodes were removed?With regard to adjuvant chemotherapy / anti-HER2 therapy:My first thought, based on the fact...
Would you consider off label use of olaparib maintenance in patients with somatic BRCA1 mutated pancreatic adenocarcinoma?
In addition to the comments above, it is worth observing that preliminary prospective data addressing this question was presented at AACR this year by @Dr. First Last. Her group is evaluating the role of rucaparib maintenance for patients with either germline or somatic BRCA or PALB2 mutations. Of t...
Would you re-introduce bisphosphonate or denosumab in a bone-only metastatic ER+ breast cancer patient with history of osteonecrosis of the jaw?
The ASCO, ADA, and Maxillofacial surgeon society guidelines on osteonecrosis of the jaw do not directly address this scenario. The antiresorptive effects of bisphosphonates persist for a long time after cessation due to a long half life in the bone. This is not the case with denosumab. Also bisphosp...