Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How would you treat a patient with history of stage I seminoma s/p orchiectomy with enlarging periaortic node and normal tumor markers on surveillance?
With respect to working up the enlarging lymph node, I agree with @Dr. First Last and @Dr. First Last above. If confident that this is seminoma recurrence, tumor markers normal, and if stage IIA or select stage IIB (select non-bulky, <=3cm) cases, our team advocates for radiation to the para-aortic ...
How would you manage a Stage IV NLPHL that has residual hypermetabolic disease involving the bilateral neck/SCV following RCHOP x 4 cycles?
Nodular lymphocyte predominant Hodgkin lymphoma is an unusual disease, developing in ~450 patients each year in the United States. While the WHO classification still categorizes this entity as a Hodgkin lymphoma subtype, the International Consensus Classification refers to this disease as "nodular l...
What is your treatment of choice in ALK-positive lung adenocarcinomas that have progressed on alectinib with resistance mutations that are not G1202R?
Lorlatinib has high response rates with any resistance mechanism.
What factors impact your decision to include bevacizumab with primary chemotherapy for patients with BRCA+ or HRD+ ovarian cancer?
The decision for bev isn’t based on HRD or BRCA biomarkers – it is based on clinical factors and provider preference. Bev is approved for all epithelial ovarian cancer, advanced stage with and to follow platinum based chemotherapy based on a clinically and statistically significant improvement in PF...
Will you offer patients urea-based creams or topical diclofenac for hand-foot prophylaxis with capecitabine after the D-TORCH trial results?
This study was presented at ASCO, Abstract 12005. Patients with breast or GI cancers treated with single agent capecitabine (1,000 mg/m2 bid) were randomized to treatment with prophylactic diclofenac cream bid x 12 weeks vs placebo. Primary endpoint was incidence of grade 2 or greater HFS. HR for th...
How do you approach need for adjuvant therapy after R0 resection of breast angiosarcoma?
In light of the improved outcomes seen in patients receiving IO +/- olaparib, what role, if any, do you think pelvic radiation still plays in the management of patients with advanced endometrial cancer?
The study included a wide spectrum of patients including advance stage with residual disease or recurrent with or without residual disease. Prior RT when indicated was allowed and about 40% had RT as part of care.
How have you incorporated mirvetuximab into the treatment of platinum-resistant ovarian cancer?
This question is going to be increasingly important in the current landscape of ovarian cancer management. I have prioritized early ordering of biomarker testing so that I have the test profiles available at recurrence, particularly in the platinum-resistant standpoint.I find that toxicity, patient ...
If neoadjuvant therapy is indicated for luminal A breast cancer, when do you decide to use chemotherapy versus endocrine therapy?
My practice is to perform recurrence risk assay on biopsy specimen and decide on the choice of neoadjuvant therapy (chemo vs anti estrogen). A clear indication for chemotherapy would not require a recurrence risk assay.
Should testing for genetic causes of HLH be performed in all patients with MAS or secondary HLH regardless of the patient's age?
Familial HLH (fHLH) is a pediatric disease. Therefore, there is no place for genetic testing to establish a diagnosis of fHLH in adults, and treatment for HLH should not be delayed while waiting for genetic testing. However, there are hypomorphic polymorphisms in the fHLH genes that may be a contrib...