Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Would you give adjuvant Tamoxifen to a premenopausal with ER+/PR+/HER2- Stage IA [pT1a, pN0(I+1)] breast cancer s/p bilateral mastectomies?
Yes.The presence of ER+ disease confers a small but real risk of distant recurrence, as evidenced by Pan et al., PMID 29117498. In the retrospective by Sasada et al., PMID 37688665, the absolute 10-year risk of recurrence for pT1a/b N0 was 2.6% (Dropped to 1.5% in the ET group, although this was not...
Do you offer a curative surgery (Whipple procedure) to patients with duodenal adenocarcinoma, with 2-5 liver metastases, and with near CR after 3-6 months of FOLFOX chemotherapy?
While Dr. @Dr. First Last correctly states that this is a rare situation and therefore a "data-free" zone, the answer may depend on how one perceives duodenal cancer: is it akin to colon cancer or more aligned with gastric or upper GI cancer? While small bowel and colon cancers exhibit several biolo...
Is there data to support the substitution of docetaxel with nab-paclitaxel in the TCHP neoadjuvant regimen in the event of hypersensitivity?
I am not aware of extensive data. I do see a couple of case reports: Pellegrino et al., PMID 29083340. There is a nice summary of chemotherapy for HER2 disease provided by ASCO published recently, "Tailoring Neoadjuvant Therapy in Human Epidermal Growth Factor Receptor 2–Positive Early Breast Cancer...
How would you approach a patient with biopsy-proven extrapulmonary small cell carcinoma (CT chest negative), characterized only by inguinal lymphadenopathy, who is otherwise asymptomatic?
Concurrent chemoradiation with etoposide and cisplatin and radiation to large inguinal field. Patient should have brain MR before and after therapy. It is not known whether PCI should be offered at conclusion. I would not push hard for that.
Would you offer adjuvant endocrine therapy for a postmenopausal female with stage III triple positive multicentric breast cancer (DCIS and invasive ductal carcinoma) s/p neoadjuvant TCHP followed by bilateral mastectomy with no residual disease?
This woman is among the 40-50% of patients with ER-positive/HER2-positive cancer who achieve pathological CR with neoadjuvant TCHP. The benefit of adding endocrine therapy to chemotherapy in this setting is unknown. Since the default is to give adjuvant endocrine therapy, many of the relevant neoadj...
Would you recommend adjuvant endocrine therapy in combination with immunotherapy for triple negative metaplastic breast cancer with residual disease that is ER strongly positive?
Immunophenotypic changes are not rare after neoadjuvant chemotherapy for breast cancer. Several recent publications addressing this issue have suggested that the discordance between pre-chemotherapy and post-chemotherapy estrogen receptors, progesterone receptors, and HER2 is around 10%, 20%, and 10...
Are there any contraindications to BCS and adjuvant radiotherapy in patients with BARD1 mutation?
BARD1 may be a moderate risk mutation predisposing to breast cancer, but with no contraindications to breast conservation treatment. There may be a slightly increased risk of developing a new primary in the treated breast, much like any other moderate risk gene.
How would you manage asymptomatic radiographic progression from M0 CRPC to M1 CRPC to bone?
This is a relatively common scenario presently where the M0-->M1 transition is now occurring during potent AR inhibition in the nmCRPC setting. In general, I manage patients similarly to mCRPC patients progressing on an AR inhibitor and consider factors such as 1) pace of disease and symptoms, 2) co...
How would you approach maintenance therapy following chemo-immunotherapy for extensive-stage small cell lung cancer per the IMPower133 trial if there is a mixed response post-treatment but clearly some clinical benefit?
The definition of clinical benefit remains a very subjective one. We presume that the patient has had an overall good response to the combination of chemotherapy and immunotherapy, and has undergone restaging imaging during the immunotherapy alone maintenance stage. The above question would suggest ...
How do you counsel patients regarding alcohol consumption following treatment of head and neck cancer?
I always tell patients that there is no known safe amount of alcohol consumption, especially regarding the risk of developing another head and neck cancer. Most patients who consume alcohol after head and neck radiation therapy often tell me that it does not provide the same enjoyment as before due ...