Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Would you add olaparib to maintenance immunotherapy for a patient with recurrent MMR-proficient, HER2-negative serous endometrial carcinoma?
I think it is reasonable to treat HER2 non-amplified USC with anti-PD-1 in addition to chemotherapy as long as they are TP53 mutated (90-95%) of tumors. This was looked at in a survival sub-analysis in RUBY. Other considerations would be bevacizumab, as there is evidence this works in TP53 mutated t...
In a patient with HER2+ advanced endometrial cancer, do you include IO(+/- olaparib) in their treatment regimen, or only trastuzumab in addition to carboplatin/paclitaxel?
This is a data-free zone and an excellent question. We don't yet know the efficacy of checkpoint inhibitor therapy in pMMR, HER2-positive, p53 mutated tumors, although the ad hoc RUBY data presented at ESMO suggest that p53 mutated tumors are responsive to immunotherapy. I eagerly await the histolog...
If a patient with recurrent endometrial cancer experiences minimal or slow disease progression on pembrolizumab or pembro/lenvatinib, would you consider continuing or would you change agents?
Great question with unfortunately no perfect answer. There are several things that need to be considered if there is slow or minimal progression. Is this true progression (patient is on immunotherapy)? How well is the patient tolerating the therapy (are toxicities worth the benefit in this patient)...
What is your adjuvant therapy for node positive, low grade endometrioid endometrial adenocarcinoma?
Chemotherapy (typically carboplatin/paclitaxel x 6 cycles), restage, and if no progression, whole-pelvic RT. Consider brachytherapy boost if cervical stromal or vaginal involvement and/or presence of other risk factors for vaginal cuff recurrence (e.g. LVSI, deep myometrial invasion, grade 3 [not in...
Would a HER2 mutation on NGS of a biopsy of a breast cancer liver metastasis change your management if the met is HER2- by IHC with the initial localized disease being HER2+?
Activating ERBB2 (HER2) mutations can be seen in breast cancer without amplification of the gene in 1-3% of cases, but can be higher in patients who have been treated with hormonal therapy for hormone receptor-positive disease at a higher rate, perhaps 5% or even as high as 10% being reported in lob...
How would you manage a bulky, locally advanced endometrial cancer with extensive parametrial involvement in a patient inoperable due to medical comorbidities?
PET CT staging. If suitable for definitive treatment, EBRT (concurrent chemo if able to get it) plus HDR brachytherapy.
Do you follow GOG, ASTRO, or PORTEC recommendations for adjuvant therapy in stage I endometrial cancer patients?
I believe the current ASTRO guidelines encompass the older GOG and PORTEC guidelines for the most part and we follow these guidelines though we review all for the sake of completeness.For the first patient, barring other risk factors, I would offer adjuvant vaginal cuff brachytherapy; for the second...
Would you consider offering immunotherapy +/- olaparib to a patient with early-stage endometrial carcinoma for whom you are recommending adjuvant chemotherapy based on improved outcomes seen in RUBY/DUO-E/NRG-GY018?
I hesitate to offer the chemo/IO combination to patients with stage I disease as this is likely an overtreatment. The majority of the patients who require chemotherapy for stage I disease are those with serous and carcinosarcoma histology. Most of those patients are not even MMRd. It is unclear what...
Do you recommend stopping olaratumab in patients receiving doxorubicin/olaratumab for treatment of advanced sarcoma?
Yes, we have stopped since this data came out. Am continuing either with single agent doxorubicin or addition of a second agent such as ifosfamide in select patients.
In a patient metastatic recurrent endometrioid endometrial cancer who has a mixed response to carboplatin and paclitaxel, what is your next choice of therapy?
Understanding that there are no head to head trials comparing newer agents after failure of frontline platinum/taxane therapy, it is important to keep some issues in mind. Performance status and toxicity concerns are important given that all treatment will be palliative. 1) Patients should be offere...