Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Would you consider a cycle of EP in a patient with good risk stage IIIB seminoma on BEP but with bleomycin omitted for cycle 3?
There are many aspects to this question. Good risk stage II seminoma has a 90-99% cure rate. I presume he has had all 3 five day courses of the EP component and 6 of 9 weeks of bleomycin. An ECOG study from about 30 (!) years ago compared BEP X 3 versus 3 courses EP for all types and histologies of...
Would you consider anthracycline based neoadjuvant therapy for ER negative, HER2 positive inflammatory breast cancer in a premenopausal female given the subset not adequately represented in non-anthracycline regimen trials?
The TRAIN-2 study of non-anthracycline vs. anthracycline-based chemotherapy for HER2 positive disease did include inflammatory breast cancer and found no benefit of anthracycline-based chemotherapy over non-anthracycline based chemo. I would not give anthracycline to a HER2-positive patient just bec...
For patients with triple negative breast cancer who have a minimal response to neoadjuvant chemotherapy, do you do additional testing to sub-categorize the cancer and find a potential target (e.g. androgen receptor, etc)?
We often encounter this scenario when we have residual disease after Neo-adjuvant chemotherapy in TNBC and I think about these 3 options: ECOG Trial/ NCT02445391: Phase III Trial randomizing Platinum (4 cycles of cisplatin or Carboplatin) versus oral Capecitabine x 6 cycles. (Requires residual disea...
Which patients with rectal cancer who have not received neoadjuvant treatment do you offer adjuvant radiation to?
In order to answer this question, we may need to step back and first review the indications for radiation treatment in the neoadjuvant setting.Neoadjuvant concurrent chemoradiation or short course radiation treatment is considered to be part of the standard treatment (recommended by guidelines) for ...
How would you treat an elderly newly diagnosed tDLBCL that has previously seen R-CHOP and Bendamustine-Obinutuzumab prior to the transformative event?
I would give tafasatimab and Revlimid per the L-MIND study. I have been so impressed by this well tolerated immunotherapy regimen and the durability of responses. Literally, it looks competitive with car T cell therapy. Car, T cells would be an option, if the patient is very fit for their age and th...
How would you treat an elderly newly diagnosed tDLBCL that has previously seen R-CHOP and Bendamustine-Obinutuzumab prior to the transformative event?
I would give tafasatimab and Revlimid per the L-MIND study. I have been so impressed by this well tolerated immunotherapy regimen and the durability of responses. Literally, it looks competitive with car T cell therapy. Car, T cells would be an option, if the patient is very fit for their age and th...
Under what circumstances would you treat prostate cancer without a biopsy?
I largely agree with Dr. @Dr. First Last's comments as well as a prior post on this site in which anecdotes are cited of situations which falsely appeared suggestive of prostate cancer. As contemporary guidelines recommend treatment only in patients with localized prostate cancer with > 5-10 year li...
What initial therapy do you offer elderly patients with metastatic NSCLC with MET amplification and PD-L1 >50%?
For now, MET amplification does not impact my first-line therapy recommendations. MET amplification is a potential target - depending on how amplification is defined - particularly when mediating resistance. But the currently approved MET TKIs are for MET exon 14 mutations, not amplification. Immuno...
When starting a patient on a tyrosine kinase inhibitor for chronic phase CML, which drug do you choose upfront?
Randomized clinical trials with nilotinib and dasatinib versus imatinib have shown improved rates of molecular response for the second-generation TKIs:https://www.ncbi.nlm.nih.gov/pubmed/24311723https://www.ncbi.nlm.nih.gov/pubmed/20525993https://www.ncbi.nlm.nih.gov/pubmed/20525995Improved response...
When starting a patient on a tyrosine kinase inhibitor for chronic phase CML, which drug do you choose upfront?
Randomized clinical trials with nilotinib and dasatinib versus imatinib have shown improved rates of molecular response for the second-generation TKIs:https://www.ncbi.nlm.nih.gov/pubmed/24311723https://www.ncbi.nlm.nih.gov/pubmed/20525993https://www.ncbi.nlm.nih.gov/pubmed/20525995Improved response...