Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Would you recommend adjuvant chemo+IO +/- olaparib for patients with occult stage III disease identified after staging surgery with no measurable residual disease?
Although most of those patients were not included in the trial, it is definitely a discussion I would have for patients with MMRd tumors and would recommend it to them. I would for MMRd patients although they were not included in the trial if they had stage 3 endometrioid histology. More data on thi...
What do you view as the future role for the combination of durvalumab + olaparib + chemotherapy in the management of patients with advanced/recurrent endometrial cancer following the DUO-E trial results?
The results of DUO-E are very exciting and will serve a number of purposes. I was encouraged to continue to see that the combo of chemo IO performed better than chemo alone confirming the class effect that was seen in GY018 and RUBY. I wish there was a pre-planned comparison of the chemo/IO/Olaparib...
How would you manage a cervical cancer patient with bulky PA LNs with direct extension and/or invasion into the lumbar vertebral bodies?
I would treat with definitive intent. May do chemo IO first and then definitive chemo RT.
Would you offer adjuvant therapy following successful resection of a solitary lung recurrence of leiomyosarcoma if no other evidence of recurrent disease on PET CT?
It is reasonable to observe this patient if no evidence of other disease and surgical margins were obtained, however, many would offer adjuvant chemotherapy or radiation to the bed of the resection. If the patient had a prior treatment at the initial diagnosis, another sarcoma chemotherapy regimen c...
What is trastuzumab deruxtecan's activity for patients with CNS+ disease?
The DESTINY-Breast04 trial excluded patients with active CNS metastases so the study does not provide information on the activity of this drug in HER2-low CNS disease. In HER2-positive disease, however, CNS activity has been observed with trastuzumab deruxtecan; among patients evaluated for CNS resp...
What is your approach to the adjuvant treatment for stage IA grade 2 endometrioid adenocarcinoma without LVSI whose molecular classification is p53 abnormal (MMR intact, POLE wild type)?
These attached guidelines recommend consideration of chemo if IA with myometrial invasion. From a radiation perspective, I do brachy alone with consideration of chemotherapy. Concin et al., PMID 33397713
What are your top takeaways from SGO 2023?
There were many great presentations at SGO 2023 along with a few practice changing presentations. Two pivotal randomized phase III clinical trials enrolled advanced, metastatic endometrial cancer patients. Each demonstrated dramatic benefit with the addition of immunotherapy to chemotherapy (followe...
How do you sequence everolimus/endocrine therapy versus fam-trastuzumab deruxtecan after progression on CDK4/6i in metastatic ER+ HER2 low breast cancer?
Since the DESTINY-Breast04 trial required patients to be endocrine therapy resistant and have received 1-2 prior lines of systemic chemotherapy for metastatic disease, I would consider Enhertu only after patients progressed on everolimus and endocrine therapy.
How would you manage a Stage IB endometrioid endometrial cancer, status post staging surgery, with a rapid vaginal recurrence <1 month post operatively?
A rapid recurrence like this is unusual, but we have definitely seen it. Cuff recurrences require multidisciplinary management. The most worrisome feature of this patient is the rapidity of recurrence. For the initial management, I would probably have recommended some kind of adjuvant treatment afte...
What chemotherapy regimen would you utilize for a metastatic, poorly differentiated carcinoma of the cervix with neuroendocrine features?
I would work with pathology to define if this is a true neuroendocrine cervical cancer versus a poorly differentiated cervical carcinoma with neuroendocrine features. This could potentially impact treatment decisions. I treat patients with poorly differentiated metastatic cervical carcinoma with the...