Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
What is the role of adjuvant radiation therapy for stage III melanoma in the era of adjuvant Opdivo?
I think the role of adjuvant radiotherapy in stage III cutaneous melanoma is difficult to define at this time (June 2019). To be clear, the TROG trial mentioned above showed that adjuvant lymph node basin radiotherapy after therapeutic lymphadenectomy can decrease the chances of lymph node basin dis...
Are certain PD-L1 assays considered more accurate or reliable than others for NSCLC?
In the treatment of NSCLC, squamous or non-squamous, there are three potential checkpoint antibodies available (Nivolumab, Pembrolizumab and Atezolizumab), only one of which is tied to a companion diagnostic of PDL1 expression by IHC (Pembrolizumab) - though in both of the other antibodies, there is...
What is your approach to TNT sequencing for locally advanced rectal primaries with low volume metastatic disease to liver?
This is a very common clinical scenario for which I'm not aware of a single correct answer. I assume by "low volume" metastatic disease to the liver the question implies potentially curable through some combination of liver-directed therapies. The only part of the sequencing about which I am fairly ...
When treating stage IVB cervical cancer with both systemic chemotherapy and local pelvic radiation therapy, do you incorporate the use of bevacizumab as in GOG 240?
I generally favor starting with multi-agent systemic therapy (Carbo/Taxol/Avastin +/- Pembro) upfront to confirm that the patient is going to respond appropriately and not blossom with metastatic disease prior to making a decision of radiating the pelvis in oligometastatic cervical cancer, similar t...
Would you consider adjuvant olaparib in a patient with HER2+, high-risk, early stage breast cancer with germline BRCA mutation?
We do not yet know whether HER2 amplified cancers in women with BRCA mutations are in fact driven by HER2. However, given the remarkable efficacy of anti-HER2 therapy, I would be loath to discard the accepted strategies for managing HER2-positive disease. There is also a pragmatic challenge which is...
For a post-menopausal woman with a pT1c node negative HER2 positive breast cancer, does ER status influence your choice of adjuvant paclitaxel/trastuzumab versus docetaxel/carboplatin/trastuzumab?
Data from pivotal trials addressing adjuvant therapy options for HER2 positive cancers, like BCIRG 006 and APT, doesn't support treating ER positive, HER2 positive cancers any differently than ER negative, HER2 positive cancers.BCIRG 006 that showed TCH regimen to be as good as ACT-H (and superior t...
What is your preferred first line treatment for patients with high risk MDS who are not candidates for transplant?
My choice of first-line therapy for high-risk MDS patients that are not transplant candidates tends to still be a hypomethylating agent (HMA). I send a myeloid molecular profile on all my MDS patients and use the p53 mutation status to make a decision regarding azacitidine vs. decitabine use. For pa...
What is your preferred first line treatment for patients with high risk MDS who are not candidates for transplant?
My choice of first-line therapy for high-risk MDS patients that are not transplant candidates tends to still be a hypomethylating agent (HMA). I send a myeloid molecular profile on all my MDS patients and use the p53 mutation status to make a decision regarding azacitidine vs. decitabine use. For pa...
Would you continue adjuvant nivolumab or pembrolizumab in a resected stage III melanoma patient that developed local-only recurrence at the site of previous surgery?
I am presuming that the patient is experiencing an in-transit recurrence while receiving anti-PD-1 monotherapy. Whilst, the intention for anti-PD1 monotherapy in the adjuvant setting is to prevent distant relapses, an in-transit recurrence is the most difficult to treat with systemic therapy. In our...
How would you manage LPL with associated AL amyloidosis?
My approach here would depend upon the nature, impact, and severity of the amyloid. Is the LPL IgG or IgM secreting? Is the amyloid causing immediate physiologic harm (renal, cardiac) or asymptomatic radiographic deposits? How much lymphoma and amyloid, respectively? Treatment options include Benda,...