Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How would you treat a T2N1 ER 90%, PR 10%, HER-2 negative breast cancer in premenopausal women with a tumor abutting the pectoralis fascia with loss of fat plane, with a concern for a positive surgical margin?
I would strongly consider neoadjuvant chemotherapy to improve resectability, assess treatment response, and reduce the risk of positive margins and extensive axillary surgery. Given the tumor’s proximity to the pectoralis fascia with loss of the fat plane, there is a real concern that upfront surger...
For patients with PI3K mutated metastatic breast cancer who progress on a PI3K inhibitor, will you use an alternative PI3K inhibitor subsequently?
Currently, there is no robust clinical evidence supporting the sequential use of different PI3K inhibitors after progression on a prior PI3K inhibitor. The INAVO120 trial (and CAPItello-291 for capivasertib) excluded patients who had prior treatment with any PI3K, AKT, or mTOR inhibitor, or any agen...
What is the preferred steroid regimen for metastatic prostate cancer patients on docetaxel?
TAX 327 (Tannock Et al NEJM 2004) used prednisone 5 mg bid in all patients (Q3 week Docetaxel and weekly Docetaxel). In addition, patients received dexamethasone 8 mg 3 times (12, 3, and 1 hour) before infusion. The prior phase 2 studies did not include prednisone with Docetaxel. Historically, low-d...
Do you hold or dose modify chemotherapy with BEP or EP for severe cytopenia or renal injury when treating testicular cancer in the curative setting?
No. In terms of cytopenias on day 22, it is usually granulocytopenia that concerns treaters. I look at the CBC and you will usually see a left shift c/w rapid recovery. If one is very concerned, you can add a granulocyte stimulating factor for this cycle. In terms of renal function, I would again ...
Does 4G/5G polymorphism in the plasminogen activator inhibitor (PAI-1) gene increase the risk of thrombosis?
Venous thromboembolism (VTE) is a classical example of a multifactorial disorder where genetic and environmental factors interact to result in VTE. Of the genetic disorders, in isolation, many are weak risk factors but when combined with other genetic or one or more environmental risk factors increa...
Does 4G/5G polymorphism in the plasminogen activator inhibitor (PAI-1) gene increase the risk of thrombosis?
Venous thromboembolism (VTE) is a classical example of a multifactorial disorder where genetic and environmental factors interact to result in VTE. Of the genetic disorders, in isolation, many are weak risk factors but when combined with other genetic or one or more environmental risk factors increa...
Would you discontinue or dose-reduce tamoxifen in a patient who developed hepatic steatosis?
In the absence of liver enzyme elevation and other risk factors for developing hepatic steatosis (such as obesity and dietary habits), I would be comfortable continuing tamoxifen. However, if tamoxifen-associated hepatic injury is suspected, my preference would be to discontinue tamoxifen or change ...
For metastatic clear cell RCC, would you consider cabozantinib + nivolumab after progression on first line ipilimumab + nivolumab?
The management of metastatic clear cell RCC continues to evolve since the approval of nivolumab for salvage therapy post TKI tx. Given the activity of anti PD1 inhibition in the salvage setting, the field has investigated multiple combinations of such agents in the first line setting. The rationale ...
Is there any benefit of using aspirin to mitigate VTE risk in testosterone-induced polycythemia?
Erythrocytosis is a common adverse effect of testosterone therapy, and results from several studies suggest an association between elevated hematocrit (Hct) and risk of VTE (Braekkan et al., PMID 19833630; Ory et al., PMID 35050717). There is currently no data to support the routine use of aspirin o...
Is there any data to use PIK3CA-directed agents in mutated metastatic triple-negative breast cancer?
PIK3CA inhibitors are not currently approved for use in patients with triple-negative (ER, PR, and HER2-negative) breast cancer. There is preclinical and early clinical work that indicates promise in patients with ER/PR negative, HER2 negative, PIK3CA mutated breast. A quick search finds that there ...