Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
What approach is suggested for extended adjuvant endocrine therapy in a HR+ breast cancer?
This can be a complicated decision for which you need to take into consideration the patient's estimated risk of late recurrence, her understanding of that risk, how well (or poorly) she has tolerated the first 5 years of adjuvant endocrine therapy, and her age and comorbidities, including the prese...
Are there patients in whom you would modify the course of adjuvant durvalumab in resected gastric/GEJ adenocarcinoma following treatment with neoadjuvant FLOT + durvalumab?
I would not de-escalate or modify the adjuvant course of treatment in the D-FLOT regimen based on the pathologic results. The protocol continues adjuvant durvalumab for 10 additional cycles after FLOT, but almost 50% of patients on the trial did not undergo these full 10 additional cycles, and so if...
How should Dato-DXd be managed in the absence of necessary resources for ocular exams and referrals?
We typically send patients for baseline slit-lamp exams prior to the start of Dato-DXd. If these resources are not available, telemedicine with slit-lamp biomicroscopic photography, as well as community screening resources, can be considered. Patients should still be educated on symptoms that would ...
When, if ever, do you incorporate a dental evaluation before initiating Dato-DXd to offer guidance on oral care and help limit oral toxicity?
A formal dental evaluation can be considered, but it is unclear whether it is necessary before starting Dato-DXd. Proactive dental evaluation, when feasible, should be used, but evaluation should not delay the start of treatment. The use of good daily oral hygiene, including salt/bicarbonate and Bio...
What clinical and pathological features are you using when selecting patients for adjuvant cemiplimab in high-risk CSCC, given the differences between trial inclusion criteria and NCCN guidelines?
Identifying the select patient population who benefits from adjuvant cemiplimab for cSCC is critical. Current staging systems for cSCC are inadequate to specifically identify the tumors at highest risk for relapse and disease-specific death. The majority of high tumor category and 'high risk' cSCC a...
In pediatric patients with Hodgkin lymphoma who have a partial response after chemotherapy and multiple disease sites above and below the diaphragm, how do you approach radiotherapy planning considering cumulative dose and toxicity?
RT dose and target volume in pediatric Hodgkin lymphoma are determined according to the systemic therapy protocol being used. For example, your case suggests a patient with Stage III or IV disease. In the COG study AHOD1331, patients received either Bv-AVE-PC or ABVE-PC systemic therapy x 5 cycles a...
How would you manage a patient with family history of protein S deficiency, now with provoked VTE and low protein S?
Low protein S would need to be checked at the appropriate time. It should not be checked during acute thrombosis It should not be checked while the patient is on DOAC If the provoking factor was estrogen containing contraceptives, testing should not be performed until the patient has been off of est...
What areas do you treat with RT for an intermediate or high risk pediatric Hodgkin Lymphoma with a slow early response?
For pediatric Hodgkin lymphoma, radiation fields are really based according to the treatment protocol. If the patient was being treated per AHOD 0031, then the radiation fields would include all sites of initial involvement, assuming they don't meet the criteria for omission of RT (RER and then a CR...
What is the optimal timing for PET/CT to assess disease and treatment response with nivo + AVD?
The S1826 study did not require interim imaging. Despite this, I routinely order an imaging test prior to cycle 3, day 1 for patients on the N-AVD regimen. In most cases, I order PET/CT scans. I continue therapy in patients with a Deauville score of 4 or less (partial or complete response) rather th...
What is the optimal timing for PET/CT to assess disease and treatment response with nivo + AVD?
The S1826 study did not require interim imaging. Despite this, I routinely order an imaging test prior to cycle 3, day 1 for patients on the N-AVD regimen. In most cases, I order PET/CT scans. I continue therapy in patients with a Deauville score of 4 or less (partial or complete response) rather th...