Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
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...
Do you utilize MammaPrint testing to determine whether or not to offer neoadjuvant chemotherapy for high-risk ER+ breast cancer?
Yes, MammaPrint is a genomic test that can be used to identify ER+ patients who benefit from adjuvant chemotherapy. If a patient is predicted to benefit from adjuvant chemotherapy, she will also benefit to the same extent if she receives the treatment preoperatively.Preoperative administration may b...
How would you treat pelvic node recurrence after prior RP and adjuvant XRT prostate bed only?
RT to pelvic nodes to aortic bifurcation, boost positive nodes, plus ADT.
How would you approach treatment for patients with limited stage small cell lung cancer who, after initial carboplatin/etoposide, develop a new contralateral lung nodule confirmed as SCLC, while their primary tumor shows a partial response?
I assume the scenario is a newly diagnosed LS SCLC in a patient who was appropriately staged with PETCT, brain MRI, etc at time of initial diagnosis. Patient is then treated with definitive chemorads with 4 cycles of platinum/etoposide and xrt. At the time of re staging PETCT, a new contralateral no...
Would you still offer adjuvant chemo at 24 weeks post Whipple for a pT1c pN2 cM0 neg margins ampullary adenocarcinoma?
No, I would not.
How should cisplatin be used in head and neck cancer patients with sensorineural hearing loss?
I generally avoid cisplatin entirely in patients with pre-existing sensorineural hearing loss. Instead, I opt for carboplatin-based regimens. If alternative agents are not acceptable (young patient, willing to risk hearing loss for minimal improvement in efficacy, etc.), I carefully consider weekly ...
Do you recommend any alternative schedule for cabozantinib to make treatment compliance easier for patients with metastatic renal cell carcinoma?
There are several considerations to remember when dosing TKIs. The first is that TKIs are not curative in mRCC, so the goal should be to give the patient the lowest possible dose that will control disease while preserving QOL. Also, patient exposure (drug levels) is extremely variable from patient t...
How would you approach a completely resected DLBCL of the appendix if PET scan and bone marrow biopsy suggest no other disease?
Resected limited stage DLBCL has relatively high risk of recurrence. A recent prospective phase II trial was reported (Yoon et al. Oncotarget 2017) where patients received 3 cycles of RCHOP post resection and had an excellent 2 year PFS of 95%. Another study (Sehn et al. Annals of Oncology 2008 abst...
How would you approach a completely resected DLBCL of the appendix if PET scan and bone marrow biopsy suggest no other disease?
Resected limited stage DLBCL has relatively high risk of recurrence. A recent prospective phase II trial was reported (Yoon et al. Oncotarget 2017) where patients received 3 cycles of RCHOP post resection and had an excellent 2 year PFS of 95%. Another study (Sehn et al. Annals of Oncology 2008 abst...
What are your top takeaways in Hematologic Malignancies from ASH 2024?
Abstract 1009 - Multiple important studies were presented at the recently concluded ASH meeting. From the CLL perspective, one of the most impactful studies was the AMPLIFY clinical trial that compared acalabrutinib plus venetoclax with or without obinutuzumab versus chemoimmunotherapy for first-li...