Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How long do you give neoadjuvant therapy in resectable/borderline resectable pancreatic cancer, when you are considering chemoradiotherapy as part of your neoadjuvant strategy?
I would aim for at least 6 cycles. A recent large study from Mayo Clinic evaluated 194 patients with borderline resectable or locally advanced pancreatic adenocarcinoma treated with neoadjuvant chemotherapy followed by concurrent chemoradiation therapy. 94% of patients had an R0 resection.Only 3 fac...
What dose and formulation of GnRH agonist do you use for ovarian suppression in young breast cancer patients?
Available data is largely with the monthly formulation. I don't have a strong preference for which LHRH agent (though some payers might). The q12-week depot formulation may not maintain full suppression for younger patients. Here is my pragmatic strategy Start with monthly (q4 week). If not tolerat...
Would the presence of only mature teratoma on orchiectomy specimen lead you to consider upfront RPLND followed by adjuvant chemotherapy as opposed to upfront chemotherapy in a patient with bulky para-aortic nodal disease (cN3) and AFP/beta-HCG elevation?
If there is an elevated AFP or hCG, then by definition, he has metastatic germ cell cancer and needs chemo initially, followed almost certainly by post-chemo RPLND done by a skilled and experienced urologist.
How would you approach adjuvant therapy for large (≥4 cm), node negative, HR+, HER2- breast cancer in an elderly woman with comorbidities including neuropathy?
If multiple co-morbidities are present in an elderly patient with locally advanced HR+/HER2- breast cancer that precludes anthracycline and taxane chemotherapy regimen, then I would consider 2 options: (1) CMF regimen which is active and generally well tolerated (one can also consider upfront dose r...
What neoadjuvant regimen would you consider using for a healthy patient with node positive TNBC who is refusing anthracycline?
In a patient with node-positive TNBC not eligible for an anthracycline, or refusing an anthracycline, I would strongly consider proceeding with a platinum + taxane + pembrolizumab, mirroring the NeoPACT trial presented by @Dr. First Last at ASCO 2022, which is the same regimen of carboplatin/docetax...
What is your preferred therapy for MDS/MPN with significant leukocytosis and neutrophilia?
Depends on blast count, cytogenetics, and molecular test results, age of patient, performance status, comorbidities, etc. To bring the white count down can temporarily start with hydroxyurea. would use induction chemo versus HMA +/- venetoclax to achieve at least a partial response. can be a candida...
What is your preferred therapy for MDS/MPN with significant leukocytosis and neutrophilia?
Depends on blast count, cytogenetics, and molecular test results, age of patient, performance status, comorbidities, etc. To bring the white count down can temporarily start with hydroxyurea. would use induction chemo versus HMA +/- venetoclax to achieve at least a partial response. can be a candida...
How would you approach adjusting nivo+AVD therapy for advanced Hodgkin lymphoma if a patient develops treatment limited immunotherapy toxicity?
BV-AVD-related transaminitis is relatively common; however, even with Nivo-AVD, transaminitis is frequently observed, albeit at a lower frequency. Most of these events are self-limited and grade 1-2. Depending on the stage and severity of the event, dose holds can be employed; however, adverse event...
How would you approach adjusting nivo+AVD therapy for advanced Hodgkin lymphoma if a patient develops treatment limited immunotherapy toxicity?
BV-AVD-related transaminitis is relatively common; however, even with Nivo-AVD, transaminitis is frequently observed, albeit at a lower frequency. Most of these events are self-limited and grade 1-2. Depending on the stage and severity of the event, dose holds can be employed; however, adverse event...
What is your approach to adjuvant chemotherapy for a postmenopausal woman with pT1cN0 grade 2 ER+ breast cancer (IDC) and OncoType RS of 25?
Since the Oncotype Dx recurrence score of 25 was the upper cut-off for randomization in the TAILORx trial, and since post-menopausal women with Oncotype Dx of 25 or less did not experience any benefit from chemotherapy, I would lean towards avoiding chemotherapy in this situation. However, I would d...