Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
In rectal cancer in patients receiving total neoadjuvant therapy of FOLFOX followed by 5FU-radiation, is there a role for additional adjuvant chemotherapy based on significant residual disease at time of surgery?
To my knowledge, there is no known role for additional adjuvant treatment in patients with rectal cancer who have received total neoadjuvant therapy with FOLFOX followed by chemoradiation or short-course radiation (SCRT). As of yet, no clinical trials address this situation. Furthermore, there is no...
Would you continue bleomycin in a patient with intermediate risk stage 3B nonseminona who had a pulmonary embolism?
A PE in and of itself would not change my commitment to a bleomycin based regimen. It would be helpful to know patient age, renal function, significant other pulmonary history (COPD). I assume the patient has bona fide bone metastases, liver mets or brain mets and I will assume that the histopatholo...
Are you checking for any specific mutations in NSCLC that suggest resistance to checkpoint inhibitors?
There has been a significant amount of data both published and presented concerning the various genomic markers (mutations) that may predict for response or the absence of response to immune checkpoint inhibitor. However, in clinical practice they are not commonly used as most patients are receiving...
What therapy do you usually choose in patients with previously treated follicular lymphoma who experience early relapse (< 2 years)?
My approach to POD24 patients is to first ensure there is no evidence of transformed disease. According to a retrospective analysis led by @Dr. First Last at Memorial Sloan Kettering, as many as 40% of the POD24 patients have evidence of transformed disease if a biopsy is pursued. Clinical indicator...
What is your preferred approach to metastatic PDL1 negative TNBC?
I usually treat mTNBC (that are PL-D1 negative and BRCAwt) with single agent chemotherapy in the first line setting. However, there are some exceptions in which I would consider starting with a chemo doublet. In the setting of young age, good PS, high disease burden, and symptomatic patients with ra...
Would you consider using nab-paclitaxel/gemcitabine/cisplatin in first line setting for metastatic pancreatic adenocarcinoma?
The data recently published in JAMA Oncology are certainly intriguing and merit further study. However, this remains a very small trial of only 25-patients with uncertainty as to its real-world performance or demonstration of efficacy in a randomized trial. It also is uncertain what implications pla...
What is your approach to a patient with systemic AL amyloidosis who has achieved a hematologic response but not an organ response with CyBorD?
I would leave them alone. Treating to organ response is wrong and dangerous. Hematologic response is quick, organ response is delayed. The goal is hematologic remission; after that allow the body the time needed to heal the organs.
What is your approach in a transplant-eligible patient with relapsed classical Hodgkin lymphoma who has an area of refractory disease after salvage chemotherapy?
The goal here, especially in Hodgkin's lymphoma, is to achieve complete metabolic remission (CMR) by PET before high dose chemotherapy and autoSCT as data is clear in terms of difference in the outcome in favor of patients achieving CMR vs. those who achieved < CMR. So I would do what it takes to ac...
Do you recommend prophylactic cranial irradiation for ES-SCLC patients now that immunotherapy is included in the treatment schema?
I do not pursue PCI for most patients with extensive stage SCLC. We know the EORTC phase III study led by Ben Slotman (NEJM 2007) showed a decrease in the cumulative risk of brain metastases that translated into a survival benefit. One of the flaws of the study was the lack of baseline and regular M...
When do you recommend adjuvant chemotherapy for adenocarcinoma ex goblet carcinoid with signet ring features status post right hemicolectomy?
In general, I have always found the name of these tumors somewhat unfortunate, in that they can give the suggestion that they are indolent carcinoid tumors (like the prior name “goblet carcinoid”). These tumors can be aggressive and behave like the an aggressive adenocarcinoma component. Thus, I wo...