Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How do you approach systemic treatment for isolated CNS recurrence of ER+/HER2+ disease, with local treatment completed, with prior treatment with chemotherapy + anti-HER2 agents?
This is always a difficult scenario with no clear guidance, and I think depends on a good discussion with the patient. My preferred approach to this scenario is similar to an isolated CNS progression, in which we would not change systemic therapy if treated with local management. In this case, the p...
When would you consider initial induction chemotherapy (e.g. FOLFOX) followed by neoadjuvant chemoradiation, over neoadjuvant chemoradiation alone, in patients with locally advanced rectal cancer?
At MSKCC, we now routinely recommend induction chemotherapy (8 cycles of FOLFOX) to any rectal cancer patient who requires preoperative chemoRT. Initially, we adopted this approach for patients with particularly bulky or node-positive disease (as per @Dr. First Last's answer above) but now do it for...
In an adult patient with asymptomatic, isolated neutropenia in whom you suspect a Duffy null phenotype, at what ANC or in what situations would you do a bone marrow to look for other etiologies of neutropenia?
What a great question! Happy to answer. As you know, as many as 60% of individuals who have the Duffy null phenotype will have an ANC that is lower than the lower limit of normal in many labs BUT as you also know, the total body (in circulation + in tissues) neutrophil count in such individuals is n...
In an adult patient with asymptomatic, isolated neutropenia in whom you suspect a Duffy null phenotype, at what ANC or in what situations would you do a bone marrow to look for other etiologies of neutropenia?
What a great question! Happy to answer. As you know, as many as 60% of individuals who have the Duffy null phenotype will have an ANC that is lower than the lower limit of normal in many labs BUT as you also know, the total body (in circulation + in tissues) neutrophil count in such individuals is n...
How do the findings from the INAVO120 trial influence your decision-making process for selecting subsequent lines of therapy in patients who have relapsed after adjuvant CDK4/6 inhibition?
The earlier deployment of CDK4/6 inhibitors has the potential to influence the clinical patterns of subsequent disease progression and the underlying genomic landscape of resistance. We are continuing to strive toward delivering personalized therapy based upon each patient's unique molecular genomic...
When would you consider use of emapalumab for HLH/MAS?
The FDA has approved emapalumab for familial HLH. For secondary HLH/MAS, I typically begin with anakinra (100 mg q 6 hrs for those 40 kg or more). If this is not enough and if CXCL9 (I send on day one to have the data available) is notably elevated, then consider adding emapalumab. Alternatively, a ...
Would you administer adjuvant chemotherapy for extrahepatic cholangiocarcinoma that has received neoadjuvant therapy and achieved near CR?
If the regimen was well-tolerated and there is reason to believe that additional treatment could have been administered (preop tumor evaluation was not stalled out, suggesting ongoing response), I would favor additional therapy. You may also have a role for ctDNA monitoring but I know many are not i...
Would you administer adjuvant chemotherapy for extrahepatic cholangiocarcinoma that has received neoadjuvant therapy and achieved near CR?
If the regimen was well-tolerated and there is reason to believe that additional treatment could have been administered (preop tumor evaluation was not stalled out, suggesting ongoing response), I would favor additional therapy. You may also have a role for ctDNA monitoring but I know many are not i...
How do you counsel patients about prognosis with FIGO 2018 IIIC cervix cancer managed in the new era of chemoradiation plus immunotherapy?
The prognosis is still a function of nodal location, number of nodes, local T stage, histology, and response to the EBRT portion of treatment. The local control is closer to 90% with a predominant pattern of failure being distant (around 20-25%). Also based on A-18, 3 years PFS is around 70% and OS ...
Is there any circumstance where you would consider bevacizumab in patients with locally advanced colorectal cancer with rectouterine fistula?
I would not. In my mind, a fistula is an absolute contraindication for VEGF inhibitors of all varieties.