Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
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...
In a patient with early stage HR+ breast cancer who was perimenopausal at diagnosis but intolerant of AI, would you consider extending tamoxifen beyond 10 years?
ATLAS and aTTom trial : - 10 years of extended adjuvant Therapy. In absence of data, I will not extend Adjuvant Therapy.
How would you manage adjuvant therapy for a premenopausal female with a T1cN1mi breast IDC that is HR+ HER2 positive on biopsy, but HR+ HER2 negative on lumpectomy surgical specimen?
Overall, I agree with Dr. @Dr. First Last's response regarding treating this as a heterogenous tumor, but I would probably lean towards 4 cycles of TC (docetaxel/cyclophosphamide) for the HR+/HER2 neg component and then add 1 year of trastuzumab. This would avoid the risks of anthracyclines and pert...
How do you approach adjuvant therapy to minimize cardiotoxicity in early stage node negative HER2+ HR+ breast cancer with history of chest wall radiation and previous cardiotoxic agents for Hodgkin Lymphoma?
The recommended adjuvant treatment approach for a middle-aged patient with a history of mantle cell radiation for Hodgkin lymphoma and early-stage node-negative bilateral HER2+ HR+ breast cancer, while minimizing cardio toxicity, involves a multidisciplinary approach. Given the patient's history of...