Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
What is your approach to the adjuvant treatment for stage IA grade 2 endometrioid adenocarcinoma without LVSI whose molecular classification is p53 abnormal (MMR intact, POLE wild type)?
These attached guidelines recommend consideration of chemo if IA with myometrial invasion. From a radiation perspective, I do brachy alone with consideration of chemotherapy. Concin et al., PMID 33397713
What are your top takeaways from SGO 2023?
There were many great presentations at SGO 2023 along with a few practice changing presentations. Two pivotal randomized phase III clinical trials enrolled advanced, metastatic endometrial cancer patients. Each demonstrated dramatic benefit with the addition of immunotherapy to chemotherapy (followe...
How do you sequence everolimus/endocrine therapy versus fam-trastuzumab deruxtecan after progression on CDK4/6i in metastatic ER+ HER2 low breast cancer?
Since the DESTINY-Breast04 trial required patients to be endocrine therapy resistant and have received 1-2 prior lines of systemic chemotherapy for metastatic disease, I would consider Enhertu only after patients progressed on everolimus and endocrine therapy.
For a patient with IIIC endometrial adenocarcinoma diagnosed and treated with 6 cycles of Carboplatin/Paclitaxel two years prior, would you consider maintenance therapy with PD-L1 inhibition, given results of GY018 and RUBY?
Endometrial cancer incidence is increasing in the United States, and very little improvement in survival has been noted for advanced disease until recently. Monotherapy with immune checkpoint inhibitors have offered hope for patients with recurrence, and the recent publication of GY018 and the RUBY ...
How would you manage a Stage IB endometrioid endometrial cancer, status post staging surgery, with a rapid vaginal recurrence <1 month post operatively?
A rapid recurrence like this is unusual, but we have definitely seen it. Cuff recurrences require multidisciplinary management. The most worrisome feature of this patient is the rapidity of recurrence. For the initial management, I would probably have recommended some kind of adjuvant treatment afte...
What chemotherapy regimen would you utilize for a metastatic, poorly differentiated carcinoma of the cervix with neuroendocrine features?
I would work with pathology to define if this is a true neuroendocrine cervical cancer versus a poorly differentiated cervical carcinoma with neuroendocrine features. This could potentially impact treatment decisions. I treat patients with poorly differentiated metastatic cervical carcinoma with the...
What are your top takeaways from SGO 2022?
So many great presentations at SGO 2022! The depth of the science was amazing and the ability to co-mingle in person with new friends and colleagues was more than fabulous. Although I am asked to discuss 3 pivotal abstracts, I encourage all readers to review the many great presentations via the “OnD...
What are your top takeaways in Gynecologic Cancers from ASCO 2023?
Gynecologic oncology research was strong at ASCO 2023. Results of the following 3 pivotal studies are practice changing. Marie Plante, MD: SHAPE trial: This non-inferiority CCTG (Canadian Cancer Trials Troup) trial enrolled 700 patients with low-risk squamous cell carcinoma, adenocarcinoma or adenos...
What adjuvant therapy would you offer a patient with Stage II uterine serous carcinoma without lymph node sampling?
Since the major concern for UPSC is distant mets, these patients typically first receive 6 cycles of carboplatin/taxol after surgery at our institution. If the patient tolerates it without significant toxicity and re-staging scans are clear, we would then offer whole pelvis RT (45 Gy in 25 fractions...
Would development of a rectovaginal fistula mid-treatment with second line pembrolizumab/lenvatinib for endometrial cancer cause you to change regimens, eliminate lenvatinib, or continue current therapy?
These complications are always difficult situations. Given she is having a response to therapy and her disease is not curable, I would have a discussion with her about the option of diversion with a colostomy after imaging and discuss holding therapy perioperatively but would consider restarting aft...