Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How long would you continue second line maintenance PARP inhibitor in a patient with recurrent stage IV BRCA+ ovarian cancer who had CR and remains NED?
For patients with platinum-sensitive relapsed ovarian cancer with a partial or complete response to platinum-based chemotherapy, niraparib, olaparib, and rucaparib are approved by the FDA for maintenance therapy. While PFS outcomes are improved with these agents regardless of BRCA mutation status, t...
How do you decide between Nivolumab + Ipilimumab and Pembrolizumab or Nivolumab monotherapy in later lines of MSI-H Colorectal cancer?
The data are fairly clear that patients with the combination of nivolumab and ipilimumab is highly active based on the Checkmate-142 study (Overman, et al, JCO 36, no. 8 (March 10 2018): 773-779, 2018) showing a 55% RR with 5% CR (n=119 patients, all post at least 2 prior chemo regimens). PFS at 12 ...
What would you recommend as adjuvant treatment for a patient with Stage III melanoma?
Good question at just the right time. As of last week the treatment of stage III melanoma has dramatically changed based on 2 trials reported in the NEJM. The first trial in 906 patients demonstrating that nivolumab is superior to iplimumab with much less toxicity, was stopped early because of clear...
Would you recommend adjuvant nivolumab for patients with upper tract urothelial cancer?
For any patient with upper tract UC who is eligible for cisplatin, adjuvant cisplatin based chemotherapy would be the preferred standard of care approach. This would be supported by results from the POUT trial where patients treated with cisplatin were deprived significant DFS benefit compared to su...
Would you provide vitamin B12 supplementation to a patient on pemetrexed therapy if their B12 levels are normal or high?
Yes. B12 supplementation has been shown to decrease the risk of paresthesias.
Would you offer adjuvant chemotherapy for platinum eligible patients with pT2pN0 urothelial carcinoma of bladder or UTUC who did not receive neoadjuvant chemotherapy?
I agree with both of my colleagues that adjuvant cisplatin-based combination chemotherapy is unproven for pT2N0 bladder cancer, although the POUT upper tract urothelial carcinoma phase III trial (which demonstrated significantly improved DFS) did recruit >=pT2N0 patients to evaluate adjuvant gemcita...
Do you perform routine interval lung cancer screening in non-smokers who are 1st degree relatives of patients with non-smoking related lung cancers with known EGFR mutations?
I would not. Although there may be a measurable increase in the risk of lung cancer detected in population studies, the absolute risk is probably far below the equivalent of even a low-risk, current or former tobacco user. This is a hard conversation to have with people who believe their risk to be ...
How would you manage JAK2+ polycythemia vera during pregnancy and postpartum?
There are not a lot of data to guide us given the relative rarity of PV in adults of child-bearing age but two published studies may be helpful.An analysis of 129 pregnancies in patients with PV demonstrated that the combination of aspirin plus LMWH had a significantly lower risk of a spontaneous ab...
How would you manage JAK2+ polycythemia vera during pregnancy and postpartum?
There are not a lot of data to guide us given the relative rarity of PV in adults of child-bearing age but two published studies may be helpful.An analysis of 129 pregnancies in patients with PV demonstrated that the combination of aspirin plus LMWH had a significantly lower risk of a spontaneous ab...
Can abiraterone or enzalutamide be substituted for bicalutamide to prevent a flare when initiating ADT with a GnRH agonist for metastatic prostate cancer?
In theory, abiraterone or enzalutamide could potentially help by the mechanism to prevent or abrogate the testosterone flare when starting on GnRH agonists. In practice, however, abiraterone and enzalutamide are more difficult to obtain, need to be dispensed at specialty pharmacies, and require prio...