Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How do you manage adjuvant endocrine therapy for microinvasive HR-positive disease measuring >=1 mm in extension?
I manage unifocal T1mi disease similar to ER+ DCIS by discussing 5 years of endocrine therapy. The treatment is not so much to avert metastatic recurrence rather it is to lower the risk of a subsequent breast cancer in any remaining natural breast tissue. If they had bilateral mastectomies then I do...
How do you reconcile discordant PSMA and MRI findings in patients undergoing definitive radiotherapy for prostate cancer?
In the situation wherein you found something on PSMA PET that wasn’t seen on MRI, I would obtain a biopsy for 2 reasons: 1. In order to confirm the presence of distant metastasis or 2. If tissue is needed for genomic testing. Otherwise, I would not biopsy in the case of discordant imaging, since I w...
In a patient with BRCA2 mutation and contralateral axillary recurrence of ER+ IDC with an ESR1 CCDC170 fusion on NGS testing, would you use standard adjuvant AI therapy or consider adjuvant SERD therapy (fulvestrant/elacestrant)?
A lot of information is missing, like menopausal state, initial dx, previous chemo or no chemo, previous hormone status, adjuvant hormone therapy, type of hormone therapy if yes, and time of recurrence. All these are required for decision-making.
How do you decide between adjuvant trastuzumab vs trastuzumab/pertuzumab in a patient with localized HER2+ breast cancer post neoadjuvant TCHP who has achieved a pCR?
After the TRYPHAENA trial, TCHP became the standard of care neoadjuvant regimen for patients with Her-2+ localized breast cancer that was either LN+ or >2 cm in size primary tumor. This was based on a superior pCR rate of 67% compared to other regimens on this study. The standard of care at this tim...
How would you manage recurrent migratory lower extremity thrombophlebitis that occurs despite being on therapeutic apixaban?
The differential diagnosis of Trousseau syndrome (migratory superficial thrombophlebitis) is relatively broad and includes both inflammatory states and undetected proximal DVTs. So I think the short answer about venogram is "maybe," based on how clear is the view by ultrasound. This isn't a typical ...
Now that ropeginterferon is approved for PV, how do you select patients for this therapy?
First, I have no conflicts of interest with respect to ropeginterferon (rPegIFN). rPegIFN is a long-acting version (once every two weeks administration) of pegylated interferon (PegIFN) as opposed to once per week, which has been used for decades for the treatment of CML and MPN patients, without ra...
Now that ropeginterferon is approved for PV, how do you select patients for this therapy?
First, I have no conflicts of interest with respect to ropeginterferon (rPegIFN). rPegIFN is a long-acting version (once every two weeks administration) of pegylated interferon (PegIFN) as opposed to once per week, which has been used for decades for the treatment of CML and MPN patients, without ra...
Would you utilize OncotypeDX to guide decision making for a male with ER+ HER2- breast cancer and 1-3 positive sentinel lymph nodes?
I would be wary of using Oncotype Dx to guide treatment decisions for males with 1-3 positive lymph nodes. If we learnt anything from the prospective RxPONDER data, it’s that the biology of tumors varies in different cohorts of HR+/HER2- breast cancer patients. The Recurrence Score (RS) algorithm wa...
How would you treat an MMR-proficient T2 N0 low-rectal cancer (measuring 2 cm extending 4-6 cm from the anal verge) in a patient who wishes to preserve his sphincter?
Thanks for the question. I think a multidisciplinary approach is key here. First, I would make sure there is an MRI rectal performed confirming the stage of cancer and also clarify whether the patient would like to have organ preservation approach (not only the sphincter but also the rectum itself)....
In a patient with history of recurrent VTE despite anticoagulation, would you consider lenalidomide as part of your initial myeloma regimen?
I would still consider lenalidomide as part of the initial myeloma regimen provided that they were on therapeutic dose anticoagulation (my preference is apixaban 5 mg BID or rivaroxaban 20 mg daily). Ideally, this would be started at least 3 months after therapeutic dose anticoagulation for the most...