Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
In what clinical situations do you order NavDx?
At MSKCC, we largely use NavDx as part of our post-operative de-escalation trial in which NavDx is checked pre and post surgery to help select patients for de-escalation. If NavDx becomes undetectable after surgery: In patients with pathologic risk factors that warrant adjuvant RT, patients undergo...
In massive transfusion protocol from suspected hemorrhage, is it worth obtaining a TEG to guide transfusion?
There really is no evidence (except expert opinion) on massive transfusion protocols and outcomes. There are a few trials showing that TEG or other viscoelastic tests reduce transfusion and even improve survival or other important outcomes in hemorrhage. So given the choice, if rapid point of care T...
How would you manage a POLE mutated, p53 abnormal IA myoinvasive carcinosarcoma of the endometrium with no LVSI?
I would not change the management of IB and above non-endometrioid histology based on mutation analysis as almost all data is for endometrioid histology.
How would you treat a patient with history of stage I seminoma s/p orchiectomy with enlarging periaortic node and normal tumor markers on surveillance?
With respect to working up the enlarging lymph node, I agree with @Dr. First Last and @Dr. First Last above. If confident that this is seminoma recurrence, tumor markers normal, and if stage IIA or select stage IIB (select non-bulky, <=3cm) cases, our team advocates for radiation to the para-aortic ...
Would you favor starting with pembrolizumab or chemotherapy for a metastatic MSI-high pancreatic ductal adenocarcinoma?
This is a great question. MSI-H status in PDAC is rare, about 1-2% of all PDAC (Luchini et al., PMID 32350089). Marabelle and colleagues published one of the initial studies using pembrolizumab in MSI-H solid tumors showing a response rate of 18.2% among PDAC (22 patients) with a median duration of ...
How would you manage a Stage IV NLPHL that has residual hypermetabolic disease involving the bilateral neck/SCV following RCHOP x 4 cycles?
Nodular lymphocyte predominant Hodgkin lymphoma is an unusual disease, developing in ~450 patients each year in the United States. While the WHO classification still categorizes this entity as a Hodgkin lymphoma subtype, the International Consensus Classification refers to this disease as "nodular l...
What is your treatment of choice in ALK-positive lung adenocarcinomas that have progressed on alectinib with resistance mutations that are not G1202R?
Lorlatinib has high response rates with any resistance mechanism.
What factors impact your decision to include bevacizumab with primary chemotherapy for patients with BRCA+ or HRD+ ovarian cancer?
The decision for bev isn’t based on HRD or BRCA biomarkers – it is based on clinical factors and provider preference. Bev is approved for all epithelial ovarian cancer, advanced stage with and to follow platinum based chemotherapy based on a clinically and statistically significant improvement in PF...
Will you offer patients urea-based creams or topical diclofenac for hand-foot prophylaxis with capecitabine after the D-TORCH trial results?
This study was presented at ASCO, Abstract 12005. Patients with breast or GI cancers treated with single agent capecitabine (1,000 mg/m2 bid) were randomized to treatment with prophylactic diclofenac cream bid x 12 weeks vs placebo. Primary endpoint was incidence of grade 2 or greater HFS. HR for th...