Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How would you proceed after complete response to carboplatin/paclitaxel/bevacizumab in a patient who presented with distantly recurrent SCC of the cervix?
I favor treating this patient in accordance with patients on GOG 240 where the patients were treated until disease progression, unacceptable toxicity, or complete response. In this pivotal prospective study, combination platinum doublets with bevacizumab were shown to have high response rates, compl...
Would you offer neoadjuvant pembrolizumab to a TNBC patient with multiple pulmonary nodules and bilateral hilar adenopathy secondary to asymptomatic sarcoidosis (biopsy proven)?
Given the potential benefits of the addition of pembrolizumab to neoadjuvant chemotherapy in clinical stage IIB-III TNBC, I would favor doing so [but not for clinical stage I or small IIA (T<3 cm N0), in whom the potential benefits would be more modest], but I would monitor the patient closely for a...
Would you use fezolinetant for hot flashes for men on ADT?
I might consider it after trying the usual agents that will at least partially relieve symptoms in the majority of patients, such as low-dose megestrol or venlafaxine (there are others, but these are the ones with which I have had the most experience and success). Fezolinetant is expensive and requi...
When do you consider the addition of concurrent pembrolizumab to breast irradiation?
With the publication of KEYNOTE-522 (Schmid et al., PMID 32101663), we are seeing this scenario much more frequently as patients continue the pembrolizumab in the adjuvant setting.A post-hoc analysis of the timing of radiation in the KEYNOTE-522 trial was presented in abstract form at SABCS 2022, (P...
How would you approach first-line treatment for a patient with metastatic colon cancer who develops an anaphylactic reaction to cetuximab with FOLFOX/cetuximab/encorafenib?
In the guidelines, the fully humanized version of panitumumab can be used interchangeably where cetuximab is indicated for patients with colorectal cancer.The anaphylactic reactions are not uncommon, going back to the homology with the tick bite story.Chung et al., PMID 18337601I have encountered pu...
What are your top takeaways in GU Cancers from ASCO 2024?
Focusing on bladder cancer only, I suggest these below: @Dr. First Last: EV-302 PRO/QoL data @Dr. First Last: Dose exposure and association with ORR with EV monotherapy @Dr. First Last: CheckMate 901 - characterization of patients with complete response Antonio Cigliola: SURE-01 neoadjuvant...
What is the appropriate timeline to start post mastectomy chest wall/regional nodal XRT (+/- reconstruction) after surgery?
If the patient received neoadjuvant chemotherapy, we typically give RT prior to additional chemotherapy (ex. xeloda for triple negative with residual, TDM1 for HER2+ with residual) and try to start 4-6 weeks post-op given that they are well healed and/or reconstruction/expanders completely filled. I...
In a patient with node-positive limited-stage small cell lung cancer, how do you approach radiation in a patient whose small primary tumor resolves after one cycle of chemotherapy?
In the case of imaging CR, I delineate CTVp based on pre-chemo volumes and apply PTV margin. If less than CR, I use post-chemo volumes to delineate GTVp and then utilize 4DCT to construct ITVp followed by appropriate CTV and PTV margins. Both approaches are consistent with ESTRO ACROP guidelines pub...
How would you approach a primary small cell carcinoma of the vagina in a patient with an intact uterus and cervix?
We treat with the same principle as cervical small cell with combination of concurrent chemo with cis and RT (EBRT plus brachy) followed by adjuvant cis and etoposide. No pCI.
How would you treat locally advanced melanoma of the scalp with several in transit lesions and a metastatic lesion to the parotid if the patient is progressing on immunotherapy such as pembrolizumab?
I think it is important to first define whether this is truly primary progression or whether the patient may have a delayed response. The Society for Immunotherapy of Cancer (SITC) has some consensus guidelines for defining this:Kluger et al., PMID 32238470 It is important to recognize that these ar...