Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Are there different strategies you would utilize to monitor and manage potential resistance in patients with CML receiving asciminib?
Overall, I use similar monitoring strategies for all CML therapies, including what responses or loss of response prompt me to consider assessment for mutations that confer therapy resistance. Sometimes it is difficult to differentiate non-adherence vs emerging resistance, and thus it is important to...
How do you manage a twice-recurrent mucinous adenocarcinoma of the lower eyelid with direct involvement of the lateral rectus muscle and lacrimal duct?
These are difficult cases. In the past, I have successfully treated a couple of these tumors with neoadjuvant immunotherapy, which allows for reduction in tumor volume to allow for an eye-sparing surgery. Because the orbit is involved, radiation should not be given due to the profound complications ...
For patients with HbA1c >6 can the INAVO regimen still be utilized if the patient is otherwise fit and has a strategy for ongoing glycemic control?
Hyperglycemia is a common and significant side effect for PIK3CA inhibitors such as inavolisib. I do believe the INAVO regimen can be utilized in patients with diabetes on a case-by-case basis, with the recognition that a comprehensive management plan including diet, medications, and endocrinology s...
Would you give adjuvant Tamoxifen to a premenopausal with ER+/PR+/HER2- Stage IA [pT1a, pN0(I+1)] breast cancer s/p bilateral mastectomies?
Yes.The presence of ER+ disease confers a small but real risk of distant recurrence, as evidenced by Pan et al., PMID 29117498. In the retrospective by Sasada et al., PMID 37688665, the absolute 10-year risk of recurrence for pT1a/b N0 was 2.6% (Dropped to 1.5% in the ET group, although this was not...
Do you offer a curative surgery (Whipple procedure) to patients with duodenal adenocarcinoma, with 2-5 liver metastases, and with near CR after 3-6 months of FOLFOX chemotherapy?
While Dr. @Dr. First Last correctly states that this is a rare situation and therefore a "data-free" zone, the answer may depend on how one perceives duodenal cancer: is it akin to colon cancer or more aligned with gastric or upper GI cancer? While small bowel and colon cancers exhibit several biolo...
Is there data to support the substitution of docetaxel with nab-paclitaxel in the TCHP neoadjuvant regimen in the event of hypersensitivity?
I am not aware of extensive data. I do see a couple of case reports: Pellegrino et al., PMID 29083340. There is a nice summary of chemotherapy for HER2 disease provided by ASCO published recently, "Tailoring Neoadjuvant Therapy in Human Epidermal Growth Factor Receptor 2–Positive Early Breast Cancer...
How would you approach a patient with biopsy-proven extrapulmonary small cell carcinoma (CT chest negative), characterized only by inguinal lymphadenopathy, who is otherwise asymptomatic?
Concurrent chemoradiation with etoposide and cisplatin and radiation to large inguinal field. Patient should have brain MR before and after therapy. It is not known whether PCI should be offered at conclusion. I would not push hard for that.
Would you offer adjuvant endocrine therapy for a postmenopausal female with stage III triple positive multicentric breast cancer (DCIS and invasive ductal carcinoma) s/p neoadjuvant TCHP followed by bilateral mastectomy with no residual disease?
This woman is among the 40-50% of patients with ER-positive/HER2-positive cancer who achieve pathological CR with neoadjuvant TCHP. The benefit of adding endocrine therapy to chemotherapy in this setting is unknown. Since the default is to give adjuvant endocrine therapy, many of the relevant neoadj...
Would you recommend adjuvant endocrine therapy in combination with immunotherapy for triple negative metaplastic breast cancer with residual disease that is ER strongly positive?
Immunophenotypic changes are not rare after neoadjuvant chemotherapy for breast cancer. Several recent publications addressing this issue have suggested that the discordance between pre-chemotherapy and post-chemotherapy estrogen receptors, progesterone receptors, and HER2 is around 10%, 20%, and 10...
How would you manage a patient less than 40 years old with an incidentally found LGG, IDH mutated, 1p19q intact, s/p STR?
Update: On August 6, 2024, the FDA approved Vorasidenib for IDH-mutant low-grade gliomas based on findings from the INDIGO trial. This decision highlights the FDA's incompetence and lack of scientific integrity, clearly demonstrating that the agency prioritizes pharmaceutical companies' interests ov...