Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How do you sequence chemoradiation and chemotherapy for patients with locally advanced rectal cancer undergoing TNT based upon data from CAO/ARO/AIO-12?
At our center, we give Total Neoadjuvant Therapy (TNT) for rectal cancer, with chemotherapy delivered up-front, followed by radiation (short-course vs long course chemo-XRT).We do not use the CAO/ARO/AIO-12 study as a blueprint for our approach. CAO/ARO/AIO-12 was a phase II study of TNT evaluating ...
How do you manage patients who develop de novo or recurrent skin cancers (SCC or BCC) while on lenalidomide?
The most common hematologic malignancies in patients who have undergone stem cell transplantation and then lenalidomide maintenance are acute myeloid leukemia, myelodysplastic syndrome, and rarely acute lymphocytic leukemia (Palumbo A, Lancet Oncol, 2014, PMID 24525202 & Aldoss I, Leukemia, 2019).Le...
Would you offer adjuvant HER 2 directed therapy for ER+/PR+/HER2+ pT1-T2 N0 papillary carcinoma of the breast?
While there is consensus that invasive papillary (not micropapillary) cancer of the breast carries a better prognosis, long-term data with conventional therapies are not available to reliably determine the recurrence and mortality risks relative to more common subtypes. I would therefore use size, g...
What is the preferred approach for giving high dose methotrexate in double or triple hit lymphomas being treated with dA-EPOCH-R?
I do not usually offer HD IV methotrexate for DHL without documented CNS disease. Instead, I use 4 cycles of IT methotrexate in addition to DA R-EPOCH (Blood 2017). For patients with documented CNS involvement, you can place an Ommaya reservoir for an intensive intrathecal therapy and I recommend us...
How would you approach frontline treatment for a metastatic non-squamous NSCLC patient with MET amplification and a concurrent KRAS mutation?
There are a couple of components to this question: first, what is the role of TKI therapy in MET amplified lung cancer, and second, what is a clinician to do when there are more than one "driver" mutations (ie KRAS and MET amp in this case)? Regarding the first question, this is somewhat timely in t...
How do you manage local recurrence of a resected stage III BRAF WT melanoma occurring during or shortly after completion of adjuvant nivolumab?
Data presented at ASCO 2019 by Carina Owen suggests that with resection alone in this setting, roughly 50-60 percent of patients will develop recurrent disease. Therefore, resection alone is likely insufficient for these patients. If resection of the local recurrence is pursed, neoadjuvant or altern...
How do you decide on a salvage regimen for relapsed/refractory DLBCL, assuming a patient is transplant eligible?
What is your preferred initial treatment for metastastic primary lung liposarcoma in a fit patient?
It depends on the type of liposarcoma.
How would you treat metastatic colon CA with BRAF non-V600E mutation?
BRAF mutated metastatic colorectal cancer is about 7-10% of all metastatic colorectal cancer. When we discuss BRAF mutated metastatic colorectal cancer, we mainly/only focus on BRAF V600E mutated metastatic colorectal cancer, however, about 22% of BRAF mutations are Non-V600E which means about 2% of...
Will you incorporate immunotherapy in neoadjuvant treatment of triple negative breast cancer based off KEYNOTE-522?
Insurance issues aside, I would incorporate immunotherapy into neoadjuvant triple negative therapy. I participated in this trial and I am aware of the pathologic complete response data. I suspect that this could lead, ultimately, to FDA approval. In the meantime, if feasible, I would use the Keynote...