Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How would you manage a patient with history of locally advanced SCC of the cervix, treated with definitive chemoRT, found to have new lung lesions 6 months post treatment?
All patients with metastatic cervical cancer should first be considered for a clinical trial. This is a condition with limited effective treatment options and also disproportionately affects younger women. It is pivotal clinicians be aware of the rapidly evolving landscape of clinical therapies for ...
How do you approach adjuvant treatment for node positive high grade gastric type endocervical adenocarcinoma following radical hysterectomy?
Gastric-type endocervical adenocarcinoma (GEA) was first recognized as a distinct histologic subtype of cervical adenocarcinoma in 2020 by the World Health Organization. Adenocarcinomas account for approximately 25% of newly diagnosed cervical cancer cases worldwide, with GEA comprising around 10% o...
In what circumstance, if any, would you consider fulvestrant + capivasertib over CDK4/6 inhibitors in a patient who has HR+, PIK3CA mutant metastatic breast cancer?
A PIK3CA mutation is prognostic but not predictive for response to a CDK4/6i. The only situation I would consider skipping over CDK4/6i therapy and doing fulvestrant+capi in the 1st line metastatic setting is if the patient had recurrence on adjuvant abema/ribo +AI and NGS showed a PIK3CA mutation. ...
What starting dose of lenvatinib are you ultilizing in recurrent endometrial cancer patients initiating lenvatinib/pembro?
I start with 20 mg daily. I base this on the recent study by Makker and colleagues
How would you approach treatment for centrally recurrent cervical SCC with positive margins after excision that was not exenteration?
We treat with concurrent chemo RT with EBRT plus brachy. Total dose of brachy is based on the extent to residual disease. For positive margin as above with non oncological resection, 65-70 Gy equivalent dose. Would get MRI of pelvis with vaginal gel to assess any residual disease.
What would be your treatment approach for a patient with a new PET positive para-aortic node 3 months following completion of definitive chemoradiation for locally advanced cervical cancer?
My approach would be to treat the entire para-aortic field (above the previous field, obviously) to approximately 45 Gy with conventional fractionation, followed by a boost to the PET positive node to get to a dose of 60 Gy or so, if possible, while respecting the relevant tolerances. If the volume ...
Since the publication of DESTINY-Breast-04 have you implemented new institutional practices for characterization of HER2-low disease given known limitations in pathologist IHC evaluation?
Since the publication of DESTINY-Breast04, new institutional practices for the characterization of HER2-low disease have been implemented in my practice. The Ventana antibody is utilized, with the approved companion diagnostic recommended. However, it should be noted that the study found the Ventana...
How do you treat cervical cancer with an ovarian metastasis?
This is a data free zone but several papers report a very poor prognosis for these patients. For a limited ovarian met with pelvic localized disease, one may consider chemoradiation and add adjuvant chemotherapy (to follow) but these patients generally fail systemically. Hence, chemotherapy should b...
When using active surveillance for rising PSA after prostatectomy, at what level of PSA would you start ADT?
Given the EMBARK data (Freedland et al., PMID 37851874), I would typically treat with ADT + enzalutamide if the PSA level was between 2.0 and 5.0 ng/mL following maximal definitive local therapy (RP + adjuvant/salvage RT). This would apply only to patients with a PSADT of <9 months. For those with P...
For premenopausal patients with ER+ PR+ HER2 negative breast cancer and lymph node micrometastases, would recurrence score be most appropriately interpreted based on TAILORx data, given such patients were excluded from RxPONDER?
These patients were excluded from TAILORx. Patients with micrometastases were initially allowed in RxPONDER but then excluded after the first ~2500 patients had been enrolled (presumably because too many patients with micromets were being enrolled and the study team wanted to ensure results would be...