Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
In what scenario would you give consolidation chemotherapy after chemoradiation for stage 3 cervical cancer with a good response?
The current standard for stage IIIB cervical cancer is primary external beam radiation + concurrent cisplatin based chemotherapy + brachytherapy (see NCCN guidelines CERV6). Clearly, given the failure rate with distant metastases after primary therapy, there exists significant interest in adjuvant c...
Would you offer any adjuvant therapy for cervical cancer following total pelvic exenteration in the setting of a positive pelvic lymph node?
I am going to "eat a bit of crow" here and admit to having been schooled a bit by the esteemed Dr. @Dr. First Last. I admit to having immediately jumped to the post-rad hyst situation rather than post-exenteration, and I agree that the radicality of the operation could factor into the decision about...
Would you modify standard WPRT+brachy radiation for cervical SCC s/p negative nodal staging but aborted hysterectomy due to previously undetected superficial vaginal disease?
Would treat same with EBRT to 45 Gy in 25 fractions. (Pelvis) With concurrent chemo and brachy.
Do you treat an endometrial cancer that is microsatellite-stable but has a high TMB after progressing on platinum-based therapy with pembrolizumab?
Yes I would. Similarly, I would also treat a patient with advanced cervical cancer with Pembrolizumab. I have a patient with PDL1 negative, TMB-High squamous cell carcinoma of cervix. Submitted to insurance for coverage and she is approved for Carbo-Taxol-Bev-Pembro. It is absolutely worth a try and...
Are there any data that suggest superiority of lenvatinib + pembrolizumab vs platinum-based cytotoxic chemotherapy for advanced or recurrent endometrial cancer?
A pertinent question that we should hopefully know the answer to relatively soon. KEYNOTE-775 did not address this question. However, the LEAP-001 trial, a phase 3 randomized, open-label, study is investigating and comparing the survival outcomes of Pembrolizumab and Lenvatinib vs chemotherapy (carb...
Can trastuzumab deruxtecan be continued during radiation?
Data is limited, with the suggestion of higher necrosis with SRS. For other sites for palliation, I would not say it’s contraindicated, but caution needs to be exercised especially for the risk of increased lung and GI toxicity (because of independent toxicity from the drug and the potential for sen...
Given the negative results of GOG-0238 but the positive results of the RUBY trial, how do you manage isolated vaginal cuff recurrence of endometrial cancer?
I would favor definitive RT alone and reserve chemo plus IO for systemic or nodal relapse.
For patients with ER-negative HER2-ultralow breast cancer, how and when would you incorporate T-DXd?
I would use T-DXd in this population once I had exhausted other options (e.g., I would first use sacituzumab govitecan, and other standard later-line chemotherapies like eribulin, but then I would use T-DXd if I were able to get insurance coverage). In a case like this, I would acknowledge to the pa...
Would you recommend systemic therapy in a patient with a history of Stage III high grade serous endometrial cancer s/p resection of a solitary pulmonary metastasis after a long disease free interval?
Systemic therapy should be advised in this patient with recurrent serous endometrial cancer after surgical resection of oligometastatic disease and a long disease free interval. Before advising a specific therapy, pathologic review by an expert gynecologic pathologist for both histologic confirmatio...
Based on the data from GY018 and RUBY, do you offer immunotherapy in addition to carboplatin/paclitaxel first line to all patients with advanced endometrial cancer who qualify or only to those whose tumors are MMR protein deficient?
This is a timely question that many of us are struggling with. There is a shared desire to improve clinical outcomes in patients with metastatic, advanced pMMR EC. As you know, both the NRG GY018 and RUBY regimens were NCCN compendium listed after publication and simultaneous presentation. Important...