Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
What is your approach to adjuvant endocrine therapy in high-risk premenopausal women with ER/PR+ Her2+ breast cancer?
There are no large scale modern era assessing the role of adjuvant hormonal therapy in patients with HER2+ and hormone receptor positive breast cancer. Data from metastatic trials and cohort studies do suggest that there is an interaction with concurrent hormonal and HER2-targeted therapy and the tw...
How do you decide between RPLND vs. chemotherapy in patients with Stage IIA mixed germ cell tumor as primary treatment?
I agree but would add a few comments: If there is a rising hCG or AFP above normal values, we prefer BEP X 3 rather than RPLND. If the patient > age 50, EP X 4. Also, we consider any AFP < 25 to be “ normal” despite many labs listing 0-8 as their normal range. Our group recently published data in J...
What is the optimal approach to managing oral toxicities, such as dysgeusia, caused by immune checkpoint inhibitors (ICIs)?
Unfortunately, this is a very strange side effect of ICI. I have seen this a few times in my clinic, and mechanistically, in my humble opinion, this is a neurologic irAE. I also notice patients losing tremendous amounts of weight due to the inability to taste and eat food. There is no good fix for t...
Is there any evidence for combining surgery and XRT +/- ADT for treatment of localized high risk prostate cancer?
Presumably, this is a question inquiring about planned post-operative RT. If so, surgery followed by adjuvant, post-operative radiation therapy (PORT) has been profiled extensively in several RCTs: EORTC 22911, SWOG 8794, ARO 96-02, FinnProstataX. The two more recent trials, ARO 96-02 and FinnProsta...
How do you monitor and manage minimal residual disease (MRD) in patients with core-binding factor (CBF) AML who are in remission post-induction and consolidation therapy?
For the purposes of this question, we will presume this refers to patients who are MRD-negative by a PCR-based methodology and have completed induction chemotherapy and consolidation.Puckrin et al., PMID 31896684 reported on 114 patients with CBF-AML who were treated with intensive chemotherapy and ...
How do you monitor and manage minimal residual disease (MRD) in patients with core-binding factor (CBF) AML who are in remission post-induction and consolidation therapy?
For the purposes of this question, we will presume this refers to patients who are MRD-negative by a PCR-based methodology and have completed induction chemotherapy and consolidation.Puckrin et al., PMID 31896684 reported on 114 patients with CBF-AML who were treated with intensive chemotherapy and ...
How would you treat a patient with newly diagnosed ALK+ Stage IIIB non-small cell lung cancer (NSCLC)?
Stage IIIB encompasses T3-4N2 and T1-2N3, so I will assume that we are not going to consider a neo-adjuvant approach. Standard treatment for stage IIIB ALK+ NSCLC would be definitive concurrent chemo/RT given with curative intent. Reasonable chemo regimens would be weekly carboplatin plus paclitaxel...
How would you approach a young patient with oligometastatic inflammatory triple negative breast cancer with bone only metastases?
There is no clinical trial data to provide solid guidance on how to manage oligometastatic de novo stage IV disease. We learned that surgery to the primary tumor without ablating distant mets and giving multidrug adjuvant-like systemic therapy does not improve survival. We also learned that SBRT to ...
When do you recommend incorporating HER2 testing into the diagnostic pathway for tumor types where HER2 overexpression is not commonly assessed?
I would recommend HER2 IHC testing at the time of advanced cancer diagnosis or at the next therapy change, whenever HER2-targeted therapy would be considered in the treatment course.
How would you manage a patient who developed stage III melanoma while receiving cemiplimab (cycle 10) for locally advanced cutaneous squamous cell carcinoma?
That depends on whether you want to manage the stage III melanoma in the adjuvant vs neoadjuvant setting. If adjuvant, can likely continue cemiplimab (off-label for melanoma) as it has the same MoA as other anti-PD-1 ICI. If intending to manage stage III melanoma in neoadjuvant setting, consider swi...