Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Are there scenarios where you would still prefer adjuvant nivolumab based on known pathologic risk over using perioperative durvalumab for patients with muscle invasive bladder cancer?
Adjuvant nivolumab can still be considered for patients who fit the criteria for CheckMate 274, which led to the approval of this regimen. Specifically, this refers to patients who have not had perioperative chemotherapy and have high-risk disease at the time of radical cystectomy (≥pT3N0) or patien...
How would you treat a patient with metastatic Leydig cell tumor of the testes with extensive lung and abdominal metastases (peritoneum, retroperitoneal LN and soft tissue) following orchiectomy and maximal surgical resection of abdominal disease?
Nongerm cell tumors of the testis ( Leydig, Sertoli or sex cord stromal tumors) are not curable when metastatic when they are inoperable, as the case here. I would sequence his tumor to check for a targetable mutation, but this would provide a less toxic and hopefully more effective alternative to c...
How do you approach a patient with inoperable urothelial carcinoma of the bladder with persistent non-muscle invasive disease despite intravesical BCG/IFN and intravesical chemotherapy?
T1 high grade urothelial carcinoma, with persistent disease after intra-vesicular therapy (e.g., BCG) is an aggressive disease and progression to invasive urothelial cancer is common. This entity tends to be multifocal / diffuse and transurethral resection (TURBT) alone is often inadequate as defini...
At what point do you prescribe duloxetine for the treatment of AIMS (aromatase inhibitor induced musculoskeletal syndrome)?
Results from the SWOG-1202 clinical trial were recently presented in the SABCS 2016 conference in December. (Editor note: Full publication in JCO, 11/2017). Duloxetine is a SNRI approved to treat depression, anxiety, neuropathic pain, and chronic pain syndromes including fybromyalgia. This study enr...
What level of 24h urine M protein do you consider to define active myeloma in a patient with renal insufficiency, proteinuria and monoclonal gammopathy?
When in doubt, a renal biopsy is preferred to define what is the exact disease process leading to renal dysfunction. If cast nephropathy is seen, this supports a diagnosis of myeloma. If amyloid or light chain deposition disease is seen, this also supports a diagnosis of amyloidosis or MGRS/myeloma,...
What level of 24h urine M protein do you consider to define active myeloma in a patient with renal insufficiency, proteinuria and monoclonal gammopathy?
When in doubt, a renal biopsy is preferred to define what is the exact disease process leading to renal dysfunction. If cast nephropathy is seen, this supports a diagnosis of myeloma. If amyloid or light chain deposition disease is seen, this also supports a diagnosis of amyloidosis or MGRS/myeloma,...
What adjuvant therapy do you recommend for early stage poorly differentiated small cell neuroendocrine carcinoma of the cervix after surgical resection?
As Dr. @Dr. First Last has so eloquently explained, this is a rare and aggressive tumor. Often, what we think is early stage is not early stage at all. I would recommend CT or MRI brain imaging as well as a PET/CT. if there are no distant metastases, then I would offer at least 4, and up to 6 cycles...
Based on NIAGARA data, do you now feel more comfortable offering cisplatin based chemotherapy to patients with impaired renal function?
I agree, apart from the topline positive results in the intent-to-treat population, the preplanned subgroup analysis of lower GFR patients also appears to indicate a benefit, albeit somewhat less strong than traditional criteria. This adds to evidence from the phase 3 randomized VESPER trial of ddMV...
How would you approach unresectable cutaneous angiosarcoma of the scalp?
These patients can have good outcomes with definitive chemoRT. PET and MRI brain for staging. Shave hair and have derm examine for any satellite lesions. Induction taxane-based chemo. Then chemoRT with concurrent taxol. CTV volume is controversial but needs to be generous. At a minimum, 3-5 cm in sk...
Is the currently available data from INAVO sufficient to adopt this as a new standard of care for all patients or are you awaiting overall survival and/or PROs?
The results of the INAVO120 trial are sufficient to be practice changing for patients who meet the study eligibility criteria. The improvement in progression-free survival was nearly an 8-month improvement. Although the control arm included palbociclib, which has not shown overall survival benefits ...