Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Would you treat PASH (pseudoangiomatous stromal hyperplasia) with focal ER positivity with hormonal agents?
I would not offer endocrine therapy to a woman with PASH. PASH is a benign breast disease and is felt to be mediated by hormonal induced stromal change, hence the ER positivity. Endocrine therapy is offered to women with high risk breast lesions (LCIS, ADH, ALH, etc) primarily to reduce the risk of ...
How would you counsel patients with personal or family histories of autoimmune disease on immune checkpoint inhibitor therapy for Hodgkin lymphoma?
This is also a tough question. I think patients with autoimmune endocrinopathies (especially Hashimoto’s or Type 1 DM) on stable, longstanding replacement regimens, as well as pre-existing vitiligo, are reasonable candidates for frontline PD-1 based therapies, although they certainly bear very close...
How would you counsel patients with personal or family histories of autoimmune disease on immune checkpoint inhibitor therapy for Hodgkin lymphoma?
This is also a tough question. I think patients with autoimmune endocrinopathies (especially Hashimoto’s or Type 1 DM) on stable, longstanding replacement regimens, as well as pre-existing vitiligo, are reasonable candidates for frontline PD-1 based therapies, although they certainly bear very close...
Are you dose reducing/omitting IV dexamethasone as a pre-medication for anti-emesis in patients with MIBC when using durvalumab/gemcitabine/cisplatin?
In my practice, we routinely give IV dexamethasone on the day of treatment. The question is whether or not to give extended dex on days 2-4 to prevent delayed nausea.The NIAGARA protocol did permit dex on the day of the treatment but did state "investigators should attempt to limit the use of steroi...
In patients with recurrent endometrial carcinoma, how do you decide when to offer Carboplatin/Paclitaxel +/- pembrolizumab or dostarlimab (NRG-GY018/RUBY) versus Lenvatinib/Pembrolizumab (KEYNOTE-775)?
I take into account prior therapy regimen in the upfront setting, time to recurrence, burden of disease for pMMR recurrence, and of course, patient characteristics--can they tolerate chemotherapy (again) or how concerned I am about lenvatinib toxicity in said patient? If they have not had chemothera...
How would you treat a patient with TNBC with a residual strongly PR+, ER- breast mass on mastectomy after neoadjuvant KEYNOTE 522 based chemoimmunotherapy?
I would treat such a patient the same way that I would any patient with residual TNBC after neoadjuvant chemotherapy and pembrolizumab, which depends to some extent upon the patient's stage at diagnosis and the extent of residual disease at surgery - in patients with residual disease after neoadjuva...
When would you consider first line FOLFOXIRI + Bevacizumab for metastatic colon cancer?
The phase III TRIBE study published in 2015 reported first line FOLFOXIRI with bevacizumab treatment had overall survival (OS) benefit compared with FOLFIRI/bevacizumab as first line treatment (29.8 months vs. 25.8 months, HR 0.80, p=0.03) (Cremolini et al., Lancet Oncol 2015). FOLFOXIRI/bevacizumab...
Would you consider using tamoxifen in ER-negative DCIS?
In the placebo-controlled NSABP-B24 trial, tamoxifen reduced the risk of ipsilateral and contralateral second events by 30% and 52%, respectively, when added to BCS and radiation. In a reanalysis of a subset of participants with estrogen receptor expression information, this benefit was most apparen...
What is the preferred agent for metastatic male breast cancer patient who progresses on tamoxifen and is not a candidate for chemotherapy?
This is luckily not a common scenario. Metastatic breast cancer in men is quite unusual in a typical practice, primarily because the disease is rare to begin with and we would most often see men with non-metastatic disease.Of course, the majority of breast cancers in men are ER-positive, more than w...
What is your approach to screening for malignancy in dermatomyositis patients who do not have a high risk antibody profile and whose disease responds well to treatment?
This is a great question and one that is very relevant to our clinical practice. Different myositis specific and associated antibodies seem to carry different risks in their associations with cancer. My colleague, Dr. Alexander Oldroyd, has written our current guidelines on cancer screening for pati...