Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Would you offer adjuvant AC + pembrolizumab for a triple negative breast cancer patient whose tumor progressed on carboplatin + paclitaxel + pembrolizumab on KEYNOTE-522 and required urgent surgery (ypT3 ypN0)?
In these situations, adjuvant AC should be considered. Anthracyclines have been shown to improve outcomes in high-risk TNBC in the adjuvant setting across multiple trials. CREATE-X used adjuvant capecitabine in patients who had residual disease after neoadjuvant anthracyclines and taxanes. It wasn't...
In rectal cancer patients receiving total neoadjuvant therapy, do you prefer chemotherapy followed by long-course chemoradiation, or short-course RT followed by chemotherapy?
We now have level 1 evidence showing the superiority of a few TNT regimens over standard chemoradiation->surgery->chemotherapy for these patients. There are going to be some stage II/III patients where TNT is overtreatment (ie, may be able to avoid the chemotherapy, radiation or surgery), but that c...
How does the latency from the original melanoma diagnosis affect your approach to neoadjuvant therapy in a patient with clinically detectable stage III nodal recurrence?
If the recurrence is less than 1 year from the end of prior anti-PD-1 immunotherapy treatment, that would be considered likely resistance to the therapy based on the Society for Immunotherapy of Cancer (SITC) expert consensus report on immunotherapy resistance (Kluger et al., PMID 36918224). Salvage...
How do you manage critically ill poor risk mixed germ cell tumor patients presenting de novo with extensive lung metastases and severe respiratory failure?
A few things. I would make sure the patient gets early brain imaging. I usually talk to the patient and family obviously about the severity of the condition, but also that ICU/intubation/ECMO might be needed over the course of treatment 1. I usually take the 3-day EP approach stop and watch for abou...
How long do you give maintenance pemetrexed/pembrolizumab in metastatic NSCLC treated with upfront chemoimmunotherapy?
In the Keynote trials, therapy was continued for 2 years. With a median progression free survival of approximately 8 months, the number of patients who are able to continue therapy for 2 years is small. However, if a patient does stay on therapy I follow the protocol and recommend stopping therapy a...
Would you consider the use of ruxolitinib for tumor fevers and leukocytosis?
No.
Would you consider the use of ruxolitinib for tumor fevers and leukocytosis?
No.
Do you recommend preloading with IV magnesium to decrease the risk of cisplatin nephrotoxicity?
Although there have been studies demonstrating that hypomagnesemia has been associated with an increased risk of AKI, there have been no clinical trials indicating preloading with mag prevents AKI. I would recommend to have the magnesium above 2mg/dl prior to cisplatin.
What is the optimal management of hot flashes for women receiving hormonal therapy?
There are many treatments that have been shown to be effective in randomized trials. I usually suggest patients first try vitamin e or acupuncture and if that is not effective to consider Effexor. Gabapentin can be effective and help with sleep, without as many sexual side effects as the antidepress...
Do you routinely recommend loratadine for pegfilgrastim pain?
Despite its popularity, there is not good evidence that Loratadine improves bone pain from pegfilgrastim. There are small, uncontrolled studies that suggest a benefit, however a randomized trial of Loratadine vs. placebo did not show a difference between groups in bone pain or quality of life.