Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How do the findings from the INAVO120 trial influence your decision-making process for selecting subsequent lines of therapy in patients who have relapsed after adjuvant CDK4/6 inhibition?
The earlier deployment of CDK4/6 inhibitors has the potential to influence the clinical patterns of subsequent disease progression and the underlying genomic landscape of resistance. We are continuing to strive toward delivering personalized therapy based upon each patient's unique molecular genomic...
When would you consider use of emapalumab for HLH/MAS?
The FDA has approved emapalumab for familial HLH. For secondary HLH/MAS, I typically begin with anakinra (100 mg q 6 hrs for those 40 kg or more). If this is not enough and if CXCL9 (I send on day one to have the data available) is notably elevated, then consider adding emapalumab. Alternatively, a ...
Would you administer adjuvant chemotherapy for extrahepatic cholangiocarcinoma that has received neoadjuvant therapy and achieved near CR?
If the regimen was well-tolerated and there is reason to believe that additional treatment could have been administered (preop tumor evaluation was not stalled out, suggesting ongoing response), I would favor additional therapy. You may also have a role for ctDNA monitoring but I know many are not i...
Would you administer adjuvant chemotherapy for extrahepatic cholangiocarcinoma that has received neoadjuvant therapy and achieved near CR?
If the regimen was well-tolerated and there is reason to believe that additional treatment could have been administered (preop tumor evaluation was not stalled out, suggesting ongoing response), I would favor additional therapy. You may also have a role for ctDNA monitoring but I know many are not i...
How do you approach the treatment of de novo, brain-only metastatic HER2 positive breast cancer?
Patients who present with de novo, brain-only metastases of HER2+ breast cancer are rare, and hence, there is no good clinical experience or clinical trial basis upon which to base clinical practice recommendations. The current ASCO guidelines for the management of HER2+ brain metastases call for ap...
How do you counsel patients about prognosis with FIGO 2018 IIIC cervix cancer managed in the new era of chemoradiation plus immunotherapy?
The prognosis is still a function of nodal location, number of nodes, local T stage, histology, and response to the EBRT portion of treatment. The local control is closer to 90% with a predominant pattern of failure being distant (around 20-25%). Also based on A-18, 3 years PFS is around 70% and OS ...
Is there any circumstance where you would consider bevacizumab in patients with locally advanced colorectal cancer with rectouterine fistula?
I would not. In my mind, a fistula is an absolute contraindication for VEGF inhibitors of all varieties.
Would you use T-DXd or capecitabine/trastuzumab/tucatinib for HER2+ metastatic breast cancer with predominantly CNS progression after THP?
We now have long-term overall survival data from the DESTINY-Breast03 (DB03) trial, which further supports the efficacy of trastuzumab deruxtecan (T-DXd) in patients with HER2+ metastatic breast cancer, including those with CNS metastases. However, my preference remains unchanged, favoring the HER2C...
How would you manage new symptomatic brain metastases (10-15) in a young woman with HER2+ metastatic breast cancer?
A lot of nuance to answering this on a per-patient basis.First question, how symptomatic? (As in, are there bulky mets that we should be considering surgical management upfront plus this also guides my discussion about whole brain vs systemic)If not acutely symptomatic and requiring a crani/resectio...
Would you offer neoadjuvant chemotherapy to premenopausal women with cT1cN0 HER2+ breast cancer?
Since most neo-adjuvant trials required that primary tumor was at least 2 cm, I tend to lean towards upfront surgery. If the tumor size is confirmed and sentinel lymph nodes are negative, the patient could be offered paclitaxel and trastuzumab which is significantly less toxic than pertuzumab in com...