Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
What is the optimal duration of ADT for cN1 disease with EBRT?
Unfortunately there are no prospective data to guide management for cN1 prostate cancer treated with EBRT. The NCCN guidelines do not comment on the optimal duration of ADT in this setting. While 18 months may be considered for some patients with high risk cN0 prostate cancer as per the PCS IV trial...
What are the options of induction treatment of young AML patients who are on CRRT, continuous renal replacement therapy ?
Hypomethylating agent like decitabine and venetoclax will be good options. C1 decitabine for 10 days and venetoclax for 28 days. Then C2 decitabine for 5 days and venetoclax every 28 days. Bone marrow biopsy should be done on day 21. There is, however, no strong literature support regarding pharmaco...
Are EGFR exon 20 insertion mutations in lung cancer predictive of a poor response to immunotherapy?
Exon 20 insertion mutations are predictive of a poor response to approved EGFR TKI therapies, but little data exists regarding responsiveness to immunotherapy for these patients. A 2018 ASCO presentation (1) showed better efficacy with ICIs in patients with exon 20 insertions compared to patients wi...
How do you approach patients for definitive chemoradiation in locally advanced NSCLC who have severe neuropathy?
If the patient and treating physician are willing to take a calculated risk for a curative intent CRT, I would consider low dose carboplatin (per JCOG 2012 or weekly AUC 2) as chemosensitizer with close monitoring, then consolidation with durvalumab if no progression on CRT and no contra-indication ...
Would you consider using immunotherapy off-label in metastatic pancreatic cancer with high PD-L1 expression?
This is an interesting question. PD-L1 expression confers a poor prognosis in pancreas cancer and expression was historically thought to be low, however, more recent data suggests otherwise (Zheng, JNCI, 2017) however, analogous to other diseases there are many limitations related to antibodies used...
How do you treat patients with stage III squamous cell carcinoma of the lung with persistent/progressive disease despite concurrent chemoradiation?
In patients with persistent disease without true radiographic progression outside the radiation fields, proceeding with consolidation durvalumab per the PACIFIC trial is reasonable. The robust benefits of durvalumab in the PACIFIC trial were likely from treatment of both persistent and micrometastat...
What is your preferred neoadjuvant chemotherapy regimen for muscle invasive bladder cancer, adequate performance status and preserved kidney function?
I agree, to date there is a lack of published randomized phase 3 data to date (though this is ongoing with NCT01812369) Several retrospective analyses such as one by Peyton et al JAMA Oncol 2019 found that neoadjuvant dose-dense methotrexate, vinblastine, doxorubicin, and cisplatin (ddMVAC) produced...
Do you prefer hyper-CVAD or the CALGB 9111 protocol for high intensity remission induction treatment in Ph-negative ALL patients?
It depends on the patient's age. Historically, the adolescents and young adults (AYAs) population, arbitrarily defined by the National Cancer Institute as those between the ages of 15 to 39 years old, had worse outcomes compared to children with B-ALL (EFS of 30-40%). This is largely driven by adver...
Would you consider first line FOLFOXIRI and cetuximab or panitumumab for physically fit patients with metastatic RAS/BRAF WT colon cancer?
The VOLFI study is a phase II trial comparing modified FOLFOXIRI plus panitumumab to mFOLFOXIRI. The study showed an improved overall response rate (ORR) of 87.3% v 60.6% (odds ratio, 4.469; 95% CI, 1.61 to 12.38; P = .004). The secondary resection rate was also improved with the addition of panitum...
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...