Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
What is your preferred treatment for refractory warm autoimmune hemolytic anemia with autoimmune neutropenia?
For immunomodulation, have you trialed IVIG? If not, this would be worth a trial. For immunosuppression, I prefer to utilize a more T cell-directed agent after failure of steroids/rituximab. Thus, a trial of MMF or cyclophosphamide may be reasonable. I think MMF may take too long to work in a situat...
Would you offer radiation for a plasmacytoma found on piecemeal endoscopic resection of an initially presumed nasal polyp if subsequent PET/CT was negative and no surgical margin status was known?
In general, unless an oncologic procedure was performed to address a solitary plasmacytoma, I would recommend a course of RT. For a lesion removed piecemeal, the risk of residual microscopic disease is quite high. As the lesion was small and only microscopic disease (presumably) remains, given the n...
Would you consider first line osimertinib to patients with an EGFR Exon 18 G719X mutation?
Yes, I would consider osimertinib. Afatinib is the only EGFR TKI that is FDA-approved for the rare sensitizing EGFR mutations based on pooled data from LUX-Lung 2/3/6. These studies included 18 patients with G719X mutations with a RR 78%, PFS 14 mo., and OS 27 mo. (Yang et al., PMID 26051236) Other ...
Would you offer adjuvant chemotherapy for MSI-H Stage II colon cancer with multiple high risk features?
About 15-20% of colorectal cancers are found to be MSI-high. These tumors are generally associated with a superior prognosis to those who are MSI-stable. Thus, the question as to whether one should utilize adjuvant chemotherapy in the context of patients with stage II disease, a setting where adjuva...
What does bevacizumab contribute in metastatic cervical cancer when used in combination with a platinum doublet + pembrolizumab?
I'm not sure how to answer the question. GOG 240 established paclitaxel/carboplatin/bevacizumab as the standard for first-line therapy for metastatic or recurrent cervical cancer.The BEATcc trial was a subsequent phase III trial for stage IVB, recurrent or metastatic cervical cancer that randomized ...
How would you treat a patient with HER2 positive CNS only progression on fam-trastuzumab which had previously progressed on tucatinib/capecitabine/trastuzumab, and has failed both SRS and WBRT?
I would present or refer her case to a multidisciplinary tumor board to 1) review her MRI to confirm there is progression vs. therapy changes, 2) see if she is a candidate for resection or irradiation of the progressing lesion (possibly using bevacizumab to reduce risk of radiation necrosis), and 3)...
How do you discuss harms of MGUS screening with other medical providers?
I understand the intent of the question, but - as always - real life is more complicated. I agree that the evidence for screening completely healthy patients for MGUS does not currently exist. But, for patients with unexplained pertinent lab/imaging findings or symptoms, it's not unreasonable. In th...
How do you discuss harms of MGUS screening with other medical providers?
I understand the intent of the question, but - as always - real life is more complicated. I agree that the evidence for screening completely healthy patients for MGUS does not currently exist. But, for patients with unexplained pertinent lab/imaging findings or symptoms, it's not unreasonable. In th...
Would you give adjuvant chemo for a mucinous stage II adenocarcinoma of the colon in the lack of other high-risk clinical pathological features?
The mucinous feature is reported to be a poor prognostic feature in colorectal cancer based on some retrospective series (e.g., Symonds and Vickery, PMID 177180, Green et al., PMID 8380140, Catalano et al., PMID 21531784, and Ott et al., PMID 29870979). However, there are some other studies suggesti...
What chemotherapeutic regimen would you prefer in patients with T1N0 triple-negative breast cancer, assuming no contraindications to taxanes and anthracyclines?
In the joint analysis of the ABC (Anthracyclines in early Breast Cancer) presented at ASCO 2016 there was a 30% relative increased risk of invasive recurrence for women with ER/PR-negative, node-negative disease when an anthracycline was omitted (HR 1.31). Further subset analyses by tumor size were ...