Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Are there specific findings that would make you suspicious of IgD or IgE monoclonal gammopathies?
I mostly consider an IgD or IgE monoclonal gammopathy in a patient who has a measurable serum M-spike on serum protein electrophoresis but a serum immunofixation that only shows a light chain band (either kappa or lambda). Since patients with light chain-only myeloma usually have at most a tiny mono...
What systemic therapy would you recommend for a patient with metastatic triple negative breast cancer (HER2 1+) who has progression of brain mets after WBRT and while receiving first line chemotherapy?
There is early evidence of untreated intracranial metastasis activity (overall response rate 73%; 11/15 patients) with trastuzumab deruxtecan (T-DXd) in patients with HER2+ breast cancer (1), but such data are not yet available for HER2-low breast cancer. Therefore, I would advocate a standard appro...
In a young patient with recurrent low-grade glioma s/p gross total resection, is there any role for further observation instead of radiation and chemotherapy?
As simple as this question seems to be on the surface, it is actually a very difficult clinical scenario to opine with certainty, primarily because of a lack of data. So, let us address this with each option in mind, weighing the pros and cons: Observation: We do know that in resected patients, radi...
How do you approach the management of patients with locally advanced unresectable mucosal melanoma in the head and neck region?
I start them either on ipi (3 mg/kg)/nivo (1 mg/kg) or a clinical trial with similar immunotherapy drugs. Indeed, I had 2 such cases yesterday in the clinic who have at least a partial remission. If feasible, a new biopsy should be done after about 4 cycles to look for viable cancer. If there is a g...
How long would you anticoagulate for PE developed after air travel in a woman on an estrogen-containing vaginal ring for contraception?
This patient has two transient (“provoking”) factors that may have contributed to her pulmonary embolism (PE): the use of estrogen-containing contraception and, presumably, a recent long-haul air travel. Traditionally, it has been assumed that, after three months of treatment for the initial venous ...
Would you consider a distal esophageal adenocarcinoma as a GEJ cancer to be able to use immune check point inhibitor therapy?
Yes
Would you ever consider using durvalumab/tremelimumab in second line after progression on atezolizumab and bevacizumab in advanced HCC?
This is a really interesting question as primary prospective trials in this setting are limited. Following progression of atezolizumab/bevacizumab, there was a recent abstract of a phase 2 trial using the combination regorafenib + pembrolizumab (N=95 patients, cohort 1 of 68 patients having received...
How would you manage contralateral neck recurrence <6 mos. following resection and adjuvant CCRT for node positive tongue cancer?
Giving possible curative therapy as it is a local regional recurrence
In patients treated with the KEYNOTE A-18 regimen who later recur, would you rechallenge with immunotherapy again?
Limited data in this clinical scenario. Per A18 (Lorusso et al., PMID 38521086), 32 patients received ICI as post-progression therapy, 25 of whom received Pembro. I am unable to find in the supplements whether those were patients from the placebo arm or from the pembro arm.I think if the patient rec...
Would you be comfortable starting tamoxifen for a HR+ breast cancer patient with a history of early stage endometrial cancer treated via hysterectomy?
I would have no problem putting someone with early endometrial cancer on tamoxifen who had had prior hysterectomy. There is no evidence that tamoxifen would increase the risk of recurrence of the endometrial cancer. In fact, recurrent endometrial cancer is sometimes treated with a combination of tam...