Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Would you use T-DXd or capecitabine/trastuzumab/tucatinib for HER2+ metastatic breast cancer with predominantly CNS progression after THP?
We now have long-term overall survival data from the DESTINY-Breast03 (DB03) trial, which further supports the efficacy of trastuzumab deruxtecan (T-DXd) in patients with HER2+ metastatic breast cancer, including those with CNS metastases. However, my preference remains unchanged, favoring the HER2C...
How would you manage new symptomatic brain metastases (10-15) in a young woman with HER2+ metastatic breast cancer?
A lot of nuance to answering this on a per-patient basis.First question, how symptomatic? (As in, are there bulky mets that we should be considering surgical management upfront plus this also guides my discussion about whole brain vs systemic)If not acutely symptomatic and requiring a crani/resectio...
Do you utilize MammaPrint testing to determine whether or not to offer neoadjuvant chemotherapy for high-risk ER+ breast cancer?
Yes, MammaPrint is a genomic test that can be used to identify ER+ patients who benefit from adjuvant chemotherapy. If a patient is predicted to benefit from adjuvant chemotherapy, she will also benefit to the same extent if she receives the treatment preoperatively.Preoperative administration may b...
How would you treat pelvic node recurrence after prior RP and adjuvant XRT prostate bed only?
RT to pelvic nodes to aortic bifurcation, boost positive nodes, plus ADT.
Would you still offer adjuvant chemo at 24 weeks post Whipple for a pT1c pN2 cM0 neg margins ampullary adenocarcinoma?
No, I would not.
Do you recommend any alternative schedule for cabozantinib to make treatment compliance easier for patients with metastatic renal cell carcinoma?
There are several considerations to remember when dosing TKIs. The first is that TKIs are not curative in mRCC, so the goal should be to give the patient the lowest possible dose that will control disease while preserving QOL. Also, patient exposure (drug levels) is extremely variable from patient t...
How would you approach a completely resected DLBCL of the appendix if PET scan and bone marrow biopsy suggest no other disease?
Resected limited stage DLBCL has relatively high risk of recurrence. A recent prospective phase II trial was reported (Yoon et al. Oncotarget 2017) where patients received 3 cycles of RCHOP post resection and had an excellent 2 year PFS of 95%. Another study (Sehn et al. Annals of Oncology 2008 abst...
How would you approach a completely resected DLBCL of the appendix if PET scan and bone marrow biopsy suggest no other disease?
Resected limited stage DLBCL has relatively high risk of recurrence. A recent prospective phase II trial was reported (Yoon et al. Oncotarget 2017) where patients received 3 cycles of RCHOP post resection and had an excellent 2 year PFS of 95%. Another study (Sehn et al. Annals of Oncology 2008 abst...
What are your top takeaways in Hematologic Malignancies from ASH 2024?
Years ago, I was consulting with a patient who had moved to the Pacific Northwest after being diagnosed elsewhere with multiple myeloma. After engaging in initial pleasantries and just before I was about to peel away the specifics of her medical history, she stopped me in my tracks. “Did you go to A...
What are your top takeaways in Hematologic Malignancies from ASH 2024?
Years ago, I was consulting with a patient who had moved to the Pacific Northwest after being diagnosed elsewhere with multiple myeloma. After engaging in initial pleasantries and just before I was about to peel away the specifics of her medical history, she stopped me in my tracks. “Did you go to A...