Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Would you give chemotherapy to a post menopausal woman with ER/PR positive HER2 negative breast cancer, T2N1 with 3+ lymph nodes, Ki-67 30% and OncoType RS of 10?
I would not give this postmenopausal woman adjuvant with a recurrence score of 10 based on RxPONDER trial. In that trial women with recurrence scores of 25 or less were randomized to receive chemotherapy + endocrine versus endocrine therapy alone. The Kaplan Meier curves were superimposable. I would...
What adjuvant systemic therapy would you give a patient with pN2 nodal relapse of ER+/HER2- breast cancer now s/p ALND, after initial mastectomy, adjuvant TC, and 5 years of endocrine therapy?
I'll give my thoughts, but appreciate others here as well. I'm assuming this patient is likely now post-menopausal, and also assuming that they had 5 years of endocrine therapy and then relapsed off of adjuvant therapy.I'm guessing the patient did not have radiation as they had a mastectomy and did ...
What factors would you consider when deciding between tamoxifen vs OFS/AI in premenopausal women with early stage HR+ breast cancer?
I think the question is asking when would I recommend tamoxifen alone versus aromatase inhibitor plus medical ovarian suppression with agents like goserelin or leuprolide in a premenopausal breast cancer patient. There are multiple factors to consider. If she has a history of active endometriosis or...
Do you recommend axillary dissection for women with ER+ breast cancer and low risk Oncotype or Mammaprint if single node positive with only 1-2 SLN removed, to ensure <4 nodes positive?
No, I see no need to do dissection in this setting. Unless there is clinical or imaging evidence of gross disease, radiation should adequately control microscopic residual disease in the axilla.
How do you incorporate Oncotype or Mammaprint recurrence score when planning an adjuvant CDK4/6 inhibitor for high-risk early-stage HR+ breast cancer?
Oncotype DX and MammaPrint recurrence scores are not used to guide adjuvant cyclin-dependent kinase 4/6 (CDK4/6) inhibitor therapy in high-risk, early-stage, hormone receptor-positive breast cancer. However, they were used to further identify the node-negative patient population with T2 or greater t...
How would you manage a CVST secondary to a traumatic brain injury with the presence of intracranial hemorrhage?
When dealing with CVST after TBI, the mechanism of injury is not the same as a spontaneous CVST. There is often direct injury to the vein or the area overlying it. Given that these patients often have other traumatic injuries, and given the lack of clear evidence to support one therapy or another, I...
When, if ever, will you utilize T-DM1 in metastatic HER2+ breast cancer given trastuzumab deruxtecan's significantly improved efficacy vs T-DM1?
We now have very compelling data that trastuzumab deruxtecan (T-DXd) is highly effective in the second line setting and superior to T-DM1. The announcement of results came with the statement that "this study will lead to a paradigm shift in the treatment of Her2-positive metastatic breast cancer". S...
How do you reconcile the differing results of the C-POST and KEYNOTE-630 trials when discussing treatment options with high-risk CSCC patients?
I explain that the two trials enrolled different risk populations, which likely accounts for the apparent discrepancy in outcomes — but when you look closely, they actually lead to the same clinical conclusion. C-POST deliberately enriched for very-high-risk patients (using well-established adverse ...
How would you treat a patient with Gleason 8 or 9 prostate cancer, pretreatment PSA 15-24, with retroperitoneal adenopathy?
I would offer a similar approach to that described nicely by @Dr. First Last and @Dr. First Last: definitive RT+ADT+abiraterone, with SIB to the grossly positive nodes. My caveats and additions are: I start with a frank discussion with the patient re: evidence for various scenarios and general prog...
How would you manage a patient with non-mutated oligometastatic NSCLC with a brain met who underwent resection of the brain met, had 4 cycles chemoIO, and had resection of the primary lung CA with pCR and now is NED?
This is a great question, and this scenario does come up occasionally within our Thoracic Tumor Boards. What makes this scenario more complicated is the integration of immune checkpoint inhibitors into standard practice. However, this question has been addressed in the pre-immunotherapy era with num...