Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
What do you recommend for women on AI therapy who experience excessive hair loss?
In addition to the suggestions from @Dr. First Last, there was also a study reported in 2018 by Freites-Martinez et al. in JAMA Dermatology that reported a moderate to significant improvement in endocrine therapy-induced alopecia with topical minoxidil 5%. This is a relatively straightforward, over ...
How do you approach treatment for solitary fibrous tumor with a multifocal pleural-based metastatic recurrence that is surgically inoperable in a patient with good performance status?
Standard sarcoma chemotherapy does NOT work unless SFT has dedifferentiated into a frank sarcoma. For SFT, VEGFR inhibition helps. Options tested are temozolomide/bevacizumab (Park, et al. Cancer 2011), sunitinib or pazopanib.
Are you altering your use of immune checkpoint inhibitors given the risk of immune-related pneumonitis and the COVID-19 outbreak?
Nivolumab can be used every 4 weeks rather than every 2 weeks. We have to be flexible and change our approach according to circumstances.
Should we delay adjuvant breast radiotherapy for early stage breast cancers as the COVID-19 situation evolves?
This is a very tough question given the unprecedented nature of this pandemic and the fact that its duration is unknown. Recommendations will likely vary based on the density of cases in a specific geographic location and will undoubtedly change frequently given the rapidly evolving nature of this s...
How would you approach adjuvant therapy in a patient with HR+ breast cancer with a high RS (>25) given the current COVID-19 pandemic?
The starting point for consideration of adjuvant chemotherapy is to quantify the risk of a distant recurrence. For estrogen receptor positive, HER2 negative breast cancer, Oncotype Dx RS data are critical for understanding the risk of a distant recurrence1 as well as endocrine and chemotherapy respo...
How do you choose which LHRH agonist or antagonist to prescribe for ADT in patients with prostate cancer?
The choice of LHRH agonist or antagonist depends on patient factors. Most patients receive some form of leuprolide or goserelin since these allow longer intervals between injections (as compared to degarelix). Goserelin is used more for those on anticoagulation or with bleeding disorders since it is...
What dose do you use to palliate multiple myeloma in a vertebral body?
For ISS Stage 1 MM patients who are going to have an OS of over 10 years, I generally prefer a more protracted regimen of 25 Gy in 10 fractions for improved durability of pain control. I typically only treat the symptomatic VB only and use inverse planning. If there is gross epidural disease or cord...
How do you manage toxicities in patients with mPDAC receiving daraxonrasib?
In our experience, we have found several strategies effective: Rash: Doxycycline 100 mg twice daily, avoid all sun exposure and use sunscreen, apply hydrocortisone 2.5% twice daily to face and upper chest and back and neck apply emollient moisturizer to arms, legs, hands, feet at least twice daily....
Would weak PR positivity make you consider adjuvant endocrine therapy for a young pre-menopausal woman with a HER2 positive, ER negative breast cancer?
I would discuss the uncertainties, and would offer tamoxifen at the most (I would not subject the patient to the toxicities of OFS and AI). I would also have a low threshold to discontinue tamoxifen if there are toxicities. If there are minimal to no side effects, it may be worthwhile getting the th...
Has NRG-CC009 changed your approach to offering SRS over HA-WBRT as the preferred treatment for patients with brain metastases from small cell lung cancer?
Yes, it has. The authors and NRG are commended for completing this pivotal trial. We were offering MDACC SRS in select cases based on an ongoing clinical trial there as well. NRG-CC009 trial will establish a standard for SRS as the preferred modality for patients with SCLC in cases where patient sel...