Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Do you recommend concurrent chemotherapy with XRT for inoperable patients with stage I-II high-risk endometrial carcinoma?
For inoperable patients due to medical comorbidities, we have been reluctant to add chemotherapy because of the concern about side effects. For inoperable patients due to disease extent, we routinely add concurrent chemotherapy.https://www.ncbi.nlm.nih.gov/pubmed/25218303/
How do you manage a screening pap smear result of HSIL and HPV16+ in a first trimester pregnancy?
Colposcopy to rule out invasion; if invasion is suspected, then biopsy. Otherwise, wait until delivery and re-evaluate. It is unlikely that invasive disease will develop in the short time of gestation. I believe these are the ASCCP guidelines.
How do you manage a patient with cervical cancer who has FDG uptake in bilateral ischial tuberosities with lytic areas on CT correlate, and also has a history suspicious for untreated polymyalgia rheumatica with chronic symptoms in the same anatomic locations?
I would be very interested in the opinion of a rheumatologist regarding the etiology of the lytic disease in the ischial tuberosities. A decision should be made on whether to biopsy one of these lesions. My suspicion is that it is unrelated to cervical cancer, but that possibility needs to be consid...
How would you manage a patient with low-volume non-invasive endometrioid carcinoma that is found in both the endometrium and ovary (pN0)?
Isolated ovarian involvement in endometrial cancer is uncommon, and previous data from the Gynecologic Oncology Group and other single-institution series suggest that it occurs in less than 5% of patients. (Creasman et al. Cancer, 1987; Lin et al. Gynecol Oncol, 2015) Adnexal involvement when presen...
In a patient with stage IVB HER2 3+ high-grade serous endometrial cancer who had disease confined to a polyp and "microscopic" omental metastases, how long would you continue maintenance trastuzumab after chemotherapy?
Two years or until progression
Would you add olaparib to maintenance immunotherapy for a patient with recurrent MMR-proficient, HER2-negative serous endometrial carcinoma?
I think it is reasonable to treat HER2 non-amplified USC with anti-PD-1 in addition to chemotherapy as long as they are TP53 mutated (90-95%) of tumors. This was looked at in a survival sub-analysis in RUBY. Other considerations would be bevacizumab, as there is evidence this works in TP53 mutated t...
In a patient with HER2+ advanced endometrial cancer, do you include IO(+/- olaparib) in their treatment regimen, or only trastuzumab in addition to carboplatin/paclitaxel?
This is a data-free zone and an excellent question. We don't yet know the efficacy of checkpoint inhibitor therapy in pMMR, HER2-positive, p53 mutated tumors, although the ad hoc RUBY data presented at ESMO suggest that p53 mutated tumors are responsive to immunotherapy. I eagerly await the histolog...
If a patient with recurrent endometrial cancer experiences minimal or slow disease progression on pembrolizumab or pembro/lenvatinib, would you consider continuing or would you change agents?
Great question with unfortunately no perfect answer. There are several things that need to be considered if there is slow or minimal progression. Is this true progression (patient is on immunotherapy)? How well is the patient tolerating the therapy (are toxicities worth the benefit in this patient)...
What is your adjuvant therapy for node positive, low grade endometrioid endometrial adenocarcinoma?
Chemotherapy (typically carboplatin/paclitaxel x 6 cycles), restage, and if no progression, whole-pelvic RT. Consider brachytherapy boost if cervical stromal or vaginal involvement and/or presence of other risk factors for vaginal cuff recurrence (e.g. LVSI, deep myometrial invasion, grade 3 [not in...
Would a HER2 mutation on NGS of a biopsy of a breast cancer liver metastasis change your management if the met is HER2- by IHC with the initial localized disease being HER2+?
Activating ERBB2 (HER2) mutations can be seen in breast cancer without amplification of the gene in 1-3% of cases, but can be higher in patients who have been treated with hormonal therapy for hormone receptor-positive disease at a higher rate, perhaps 5% or even as high as 10% being reported in lob...