Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
What is the optimal approach for a younger female with borderline resectable cervix cancer who may need adjuvant radiation, in light of a medical history significant for ulcerative colitis?
It all depends on the colitis status on therapy including the extent and response to ongoing treatment. No induction chemo. Either radical hysterectomy with the possibility of adjuvant RT or definitive RT based on colitis status. If high risk with RT, would proceed with surgery.
Would you give T-DXd to patients with resolved drug-induced ILD from other agents such as prior chemo/targeted therapy/immunotherapy?
Depending on the pathophysiology and prior offending agent, I would consider treating such patients with TDxd. Ado-trastuzumab emtansine has been rarely associated with ILD; in this particular case, ILD caused by another HER2-targeting ADC, unless it was grade 1, I may not consider challenging the p...
When defining HER2-low status in breast cancer, are there certain IHC assays/techniques that are preferred?
As with most IHC evaluations, there are significant variations between grading pathologists. During ASCO 2022, the discussant for DB4, Dr. Patricia LoRusso very eloquently discussed this issue with IHC and specifically, how a more reproducible, quantifiable assay is needed. Until that time, IHC rema...
What are real world exclusion criteria for the use of lenvatinib + pembrolizumab for advanced endometrial cancer?
Poorly controlled Hypertension Active flare of autoimmune disease On immunosuppressant therapies
How do you treat a locally advanced cervix cancer in a patient who declines brachytherapy?
You provide this lady with a curable disease the appropriate social support, mental health support, and transportation coordination in order for her to complete curative treatment with brachytherapy. Anything short of that in America with all our incredible resources and care options is substandard ...
When, if ever, would you recommend hysterectomy after chemoradiation for patients with locally advanced cervical cancer?
We would never offer a routine hysterectomy unless a planned dose of RT can’t be derived for various reasons (very rare). If the patient has persistent disease after chemo RT, then they are considered for hysterectomy or exenteration based on extent of residual disease and surgical feasibility.
What is optimal therapy for a 5 year delayed recurrence of uterine cancer, rendered NED by solitary pulmonary metastasis resection?
I favor “pseudoadjuvant” therapy with carboplatin + paclitaxel chemotherapy for 6 cycles. I make this recommendation in the absence of strong data to suggest an improvement in outcome with chemotherapy over observation vs. hormonal therapy. The optimal therapy for this patient with recurrent endomet...
If a patient with HER2+ uterine serous carcinoma recurs while on maintenance trastuzumab, would you continue trastuzumab with second line chemotherapy?
I advise against extrapolating data from breast cancer therapies to endometrial cancer. There is no clinical trial supporting the administration of trastuzumab (or other anti-HER2 therapy) with second line chemotherapy after progression on maintenance trastuzumab in serous endometrial cancer. Rather...
Would you recommend olaparib for a patient with germline BRCA1 mutation and HER2+ metastatic breast cancer who has progressed through multiple lines of HER2-directed therapy including trastuzumab deruxtecan?
Although OlympiAD (Robson et al., PMID 28578601) and EMBRACA (Litton et al., PMID 30110579) studied olaparib and talazoparib in HER2negative gBRCA mutant metastatic breast cancer, the activity is based on the mechanism of synthetic lethality in BRCA deficient tumors. Thus, it is reasonable to think ...
How would you treat a recurrent endometrial cancer at the vaginal cuff that was initially FIGO 1A with no adj treatment, in a patient with actively treated scleroderma?
I would favor brachytherapy alone using MRI based planning with either a multichannel or hybrid applicator. Dose 6 Gy x 6 to CTV and higher dose (hot spots) to GTV.