Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Which regimen would you recommend for a young patient with node-positive, triple-negative breast cancer with significant anthracycline-induced cardiomyopathy?
I would consider the NeoPact regimen, consisting of 6 cycles of docetaxel, carboplatin, and pembrolizumab, which is currently being directly compared to the Keynote-522 regimen in the SCARLET trial. Given some immune-related cardiac risks of pembrolizumab, I would strongly recommend that the patient...
For patients with resected colon cancer, to what extent would you adapt adjuvant chemotherapy if ctDNA results don't correspond with your initial treatment recommendation?
Data in this field is evolving quickly. We will have more answers in the upcoming months as BESPOKE, SU2C MGH, more follow-up on PEGASUS presented at ESMO a few weeks ago, as well as CIRCULATE-JAPAN and CIRCULATE-US accrue and read out.Till that, the strongest evidence would be from what happened to...
What is your institutional practice for neoadjuvant therapy prior to transplanting cholangiocarcinoma?
We have largely been following the Mayo Protocol for perihilar cholangiocarcinoma, which is outlined here: A collaborative approach using liver transplant for perihilar cholangiocarcinoma treatment - we use chemoRT and capecitabine or 5FU. I do not think it would be wrong to cycle in some gemcitabin...
How would you treat a patient with concurrent diagnoses of symptomatic multiple myeloma and a newly diagnosed upper extremity undifferentiated pleomorphic sarcoma?
Partly would depend on the prognostic details of the UPS - ?size, ?resectable. Sounds like the "symptomatic MM" needs urgent treatment and should take precedence. Considering pre-op XRT followed by a planned surgical excision at an opportune time could address both active problems.
How do the results of BRAF testing change your management of colon cancer?
BRAF testing is essential for metastatic colon Cancer. The patients with BRAF mutated cancers tend to be younger, have right sided tumors, and have extensive disease. Their survival is about half of those with wild type BRAF. It is essential these patients receive FOLFOXIRI and bevacizumab therapy f...
How do you approach an isolated metastasis to left supraclavicular node in rectal cancer treated with TNT with FOLFOX regimen followed by long course radiation?
Thanks for the question! The answer depends on several factors. How soon was the recurrence? Does the patient have neuropathy? How is the performance status of the patient? I see no action in NGS, but what about RAS/RAF status?
What is the best treatment approach to a patient with HGBCL with FISH translocation of BCL-6 and c-Myc given new classification of this entity?
The International Consensus Classification (ICC) and the 2022 WHO 5th Edition have sought to refine the approach to high-grade B-cell lymphomas (HGBL) with c-Myc and BCL-6 rearrangements. As the questionnaire astutely implies, the WHO now excludes cases with concurrent c-Myc and BCL-6 rearrangements...
Would you discontinue tamoxifen for endometrial hyperplasia without dysplasia in the adjuvant setting?
I would not. Endometrial hyperplasia is to be expected on tamoxifen, especially in a postmenopausal woman. It is not recommended to do a transvaginal ultrasound or endometrial biopsy without suspicion of tamoxifen. I would not change therapy in the absence of other suspicious findings.
What parameters would you use to monitor and interpret iron levels in a hemochromatosis patient where ferritin is unreliable due to underlying chronic inflammation?
The biggest question in these situations is whether the patient truly has iron overload vs. just high ferritin. If iron sat is not elevated, true iron overload is very unlikely. If both ferritin and iron sat are elevated, but they don't have a homozygous C282Y genotype, I make sure that the patient ...
What parameters would you use to monitor and interpret iron levels in a hemochromatosis patient where ferritin is unreliable due to underlying chronic inflammation?
The biggest question in these situations is whether the patient truly has iron overload vs. just high ferritin. If iron sat is not elevated, true iron overload is very unlikely. If both ferritin and iron sat are elevated, but they don't have a homozygous C282Y genotype, I make sure that the patient ...