Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
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.
How does positive p53 staining influence your recommendation for adjuvant therapy in comprehensively staged early (stage IA or IB), grade 2, endometrioid endometrial cancers?
It does not influence my recommendations. If a study is available to potential study the risk conferred by P53, I would offer it to my patient.
Are there differences in T-DXd efficacy along the spectrum of HER2 IHC expression to impact treatment decisions or sequencing?
There do not appear to be differences in T-DXd efficacy along the spectrum of HER2 expression in these low HER2-expressing tumors as seen in Figure S2 and Figure S4. Reviewing the waterfall plot (Fig Supp 4), we see complete responses in approximately as many patients with IHC 1+ as those with IHC 2...
Do you recommend concurrent chemotherapy with XRT for inoperable patients with stage I-II high-risk endometrial carcinoma?
For inoperable patients due to medical comorbidities, we have been reluctant to add chemotherapy because of the concern about side effects. For inoperable patients due to disease extent, we routinely add concurrent chemotherapy.https://www.ncbi.nlm.nih.gov/pubmed/25218303/
If a patient is unable to tolerate one CDK 4/6 inhibitor, do you switch to a different one?
There are currently no data about switching from one CDK 4/6 inhibitor to another. The current recommendations for palbociclib with grade 3 neutropenia and infection are to hold palbociclib until recovery to grade 2 or less and then dose reduce. It sounds as though this patient has required multiple...
How do you decide on adjuvant therapy in a patient with a Stage IA uterine carcinosarcoma without any myometrial invasion?
There is no good prospective study. Our approach, based on outcome and retrospective data (including NCDB), is brachy plus chemo. https://www.ncbi.nlm.nih.gov/pubmed/30170976This is paper I was referring to. With all the caveats of NCDB studies, it givess some objective information where prospective...
How do you manage a screening pap smear result of HSIL and HPV16+ in a first trimester pregnancy?
Colposcopy to rule out invasion; if invasion is suspected, then biopsy. Otherwise, wait until delivery and re-evaluate. It is unlikely that invasive disease will develop in the short time of gestation. I believe these are the ASCCP guidelines.
How do you manage a patient with cervical cancer who has FDG uptake in bilateral ischial tuberosities with lytic areas on CT correlate, and also has a history suspicious for untreated polymyalgia rheumatica with chronic symptoms in the same anatomic locations?
I would be very interested in the opinion of a rheumatologist regarding the etiology of the lytic disease in the ischial tuberosities. A decision should be made on whether to biopsy one of these lesions. My suspicion is that it is unrelated to cervical cancer, but that possibility needs to be consid...
In a patient with stage IVB HER2 3+ high-grade serous endometrial cancer who had disease confined to a polyp and "microscopic" omental metastases, how long would you continue maintenance trastuzumab after chemotherapy?
Two years or until progression