Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
For women who have had either embryo or oocyte cryopreservation, do you also recommend administering GnRH analogs?
For anyone who is interested in fertility preservation enough to undergo egg or embryo cryopreservation, I think offering GnRH analog treatment through chemotherapy for prevention of premature ovarian insufficiency and potentially infertility makes sense. Although some women may not want to deal eve...
Would you recommend 1st line pembrolizumab for PD-L1 positive recurrent/metastatic cervical cancer patient who is not a candidate for or refuses chemotherapy?
No. First-line pembrolizumab has not yet been approved for that indication in cervical cancer. It is being studied in Keynote-826.
In a patient with inflammatory triple-positive breast cancer who has a pCR to neoadjuvant chemotherapy, but has an incidentally found focus of intermediate-grade ER+/PR+/HER2- ILC in the mastectomy specimen, how would this impact your adjuvant radiation recommendations?
This finding would not have any impact on my recommendations, since her management needs to be guided by the inflammatory breast cancer. That means chest wall plus nodal irradiation tailored to the findings of axillary surgery. There are no data on whether we can decrease the dose in patients with a...
When discussing immunotherapy with patients, how do you frame the conversation in a way that acknowledges the fact that many patients do not respond but allows for hope for a durable response?
There is certainly more than one way to do it. The best way depends on knowing the learning style and information preferences of your patient and then tempering information that they need to have to be informed appropriately. The Shared Decision Making [SDM] model encourages us to invite the patient...
In which situations do you offer ovarian suppression with chemotherapy to prevent the development of premature menopause in premenopausal women with ER negative breast cancer?
I would consider the use of GnRHa during chemotherapy in all women that are premenopausal at breast cancer diagnosis (irrespective of age) and that are concerned about developing the side effects of early menopause. Current evidence supports its use as a standard strategy for ovarian function preser...
Would you ever consider stopping immunotherapy in a patient with metastatic melanoma after achieving a good response?
Yes, I would consider stopping immunotherapy in a patient with metastatic melanoma after achieving a good response.Data of 655 melanoma patients treated in pembrolizumab phase 1 KEYNOTE-001 study has shown 95 patients (14.5%) achieved CR after a median follow-up of 32 months. Treatment was discontin...
In patients with lupus nephritis, and MAHA with positive anti-phospholipid autoantibodies, what are the considerations to use or not use anti-coagulation therapy?
I support anticoagulation and C5 inhibition for such patients if they are not adequately responding.
When will you prescribe 3 v. 6 months of FOLFOX or XELOX for the adjuvant treatment of colon cancer?
This set of studies will do more to reduce toxicity for patients than any other studies presented at ASCO this year. Based on these results, I plan on treating stage III patients as follows: 1. For T4 and/or N2 patients, I will continue to recommend FOLFOX or CAPOX for 6 months, and continue to adju...
How do you determine the timeline for healing after craniotomy prior to starting chemotherapy and radiation?
I typically wait at least 10-14 days post-op, always after neurosurgery has re-evaluated the craniotomy site for appropriate healing and has already removed staples or sutures.
How long do you treat with IMID in a case of smoldering multiple myeloma?
I have not yet adopted use of lenalidomide for SMM, as I believe in the future, we will do away with the definition of SMM—patients either have MGUS which is observed, versus MM which requires the standard platform of myeloma treatment. This will be accomplished with a better molecular understanding...