Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Do you check for EGFR and other mutations in patients with squamous cell lung cancer, including in adjuvant setting before considering immunotherapy?
Yes, I do. Our Cancer Institute performs NGS reflex testing for all patients with newly-diagnosed lung cancer, regardless of stage or histology. Although EGFR or other mutations are less common in squamous cell lung cancer, they do exist, and this also allows for testing for other mutations (MET exo...
How do you manage a patient with metastatic NSCLC whose initial mutation testing was limited or results are no longer available?
If I see a patient with new metastatic NSCLC with limited/no next-generation sequencing (NGS) testing, I will attempt to initiate testing in some way while formulating a treatment plan. Specifically, I will either attempt to do tumor based NGS if feasible and timely (goal for getting results back in...
For neoadjuvant treatment of muscle invasive bladder cancer, are you utilizing durvalumab plus gemcitabine cisplatin over dose dense or accelerated MVAC?
Neoadjuvant Dose Dense MVAC (ddMVAC) has been shown to be safe and effective in MIBC. However, given the different side effect profile compared to cisplatin gemcitabine, especially in terms of bone marrow suppression, cardiotoxicity, and neurotoxicity, the majority of patients are not receiving ddMV...
What is your approach to curative-intent therapy for a young, fit patient with newly-diagnosed monomorphic epitheliotropic intestinal T cell lymphoma (MEITL)?
If >= 10% of the cells express CD30 by IHC, I would treat with BV+CHP x 6 cycles rather than CHOP according to the ECHELON-2 trial (although this trial included only 3 patients with EATL). Historically, the 5-year OS rate with anthracycline-based chemotherapy alone is approximately 10 to 20%, so for...
What is your approach to curative-intent therapy for a young, fit patient with newly-diagnosed monomorphic epitheliotropic intestinal T cell lymphoma (MEITL)?
If >= 10% of the cells express CD30 by IHC, I would treat with BV+CHP x 6 cycles rather than CHOP according to the ECHELON-2 trial (although this trial included only 3 patients with EATL). Historically, the 5-year OS rate with anthracycline-based chemotherapy alone is approximately 10 to 20%, so for...
How can you adjust neoadjuvant or adjuvant platinum based chemotherapy for stage Stage II-III non-small cell lung cancer in patients with significant renal insufficiency?
This is a great question as to one of our key responsibilities as practicing oncologists. Properly tailoring treatment - in this example chemotherapy to our patient’s needs – recognizing particular co-morbidities of concern, his/her willingness to tolerate side effects, and striking the right balanc...
Are there any circumstances where you recommend early institution of systemic therapy for patients with solitary plasmacytoma?
Assuming a true solitary plasmacytoma with no bone marrow involvement, I do not recommend systemic therapy in almost all circumstances. However, there are times when the location of a solitary plasmacytoma precludes definitive/curative dose radiation; even with surgical resection, I would favor syst...
What stroke symptoms would lead you to avoid using oxaliplatin in a patient with metastatic colon cancer and a recent stroke?
This is not a rare situation, given colorectal cancer in general is a disease with a median age of 66 in men and 69 in women at diagnosis. If the patient is considered to be a good candidate for systemic therapy, which means the patient must recover from the recent stroke reasonably well with well-p...
How would you manage recurrent anal SCC after chemoradiation, with positive margins after resection?
There aren't many details given about the recurrence. If it is a local recurrence, I would suggest repeat attempt at surgery be considered. If it is a distal recurrence, one could consider carboplatin and paclitaxel chemotherapy (based off of this InterAAct trial). Increasingly, I am favoring checkp...
Would you offer adjuvant endocrine therapy to a patient with a history of ER-positive DCIS, s/p bilateral mastectomy, now with chest wall recurrence of DCIS four years later?
This is an unusual case, and I wonder how she presented initially and with the recurrence, and if she has a history of exposure to radiation. In addition, a pathology second opinion to confirm the lack of an invasive component is in order. Theoretically, close to all of the breast tissue should have...