Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
When would you continue atezolizumab/bevacizumab beyond progression in advanced HCC?
There are many effective drugs now in HCC. If there is true progression, I would change therapy. What is true progression? I think, a confirmed new lesion and/ or significant growth of the current disease. A few mm seen on a scan sometimes is read by radiology as PD but if the lesion is 8 mm, it's n...
Would you offer cisplatin concurrent with radiation to a patient with p53-mutated stage III endometrial cancer if she has adult-onset hearing loss and uses a cochlear implant?
Cisplatin is commonly used for radiosensitization in patients being treated for gynecologic cancer. Ototoxicity is a common side effect of cisplatin. It is caused by the death of outer hair cells in the inner ear. Cochlear implants are used to treat hearing loss in patients with severe hearing loss ...
In a patient with PDL1+ TNBC who has had an excellent response to sacituzumab govitecan + pembrolizumab, would you ever stop the SG and continue the pembro alone?
In ASCENT-04, patients received treatment until disease progression, unacceptable toxicity, withdrawal of consent, or death. Pembrolizumab was administered for a maximum of 35 cycles, which is approximately two years. The strategy of discontinuing SG and continuing pembrolizumab as maintenance thera...
How do you counsel a patient with NCCN favorable intermediate prostate cancer but a high risk Decipher score?
Active surveillance has become the preferred management strategy for most men with low-risk prostate cancer and is increasingly used in carefully selected patients with favorable intermediate-risk disease. However, men with IR PC have approximately a three-fold greater risk of tumor upgrading or pro...
Based on the data from GY018 and RUBY, do you offer immunotherapy in addition to carboplatin/paclitaxel first line to all patients with advanced endometrial cancer who qualify or only to those whose tumors are MMR protein deficient?
This is a timely question that many of us are struggling with. There is a shared desire to improve clinical outcomes in patients with metastatic, advanced pMMR EC. As you know, both the NRG GY018 and RUBY regimens were NCCN compendium listed after publication and simultaneous presentation. Important...
Under what circumstances would you treat prostate cancer without a biopsy?
I largely agree with Dr. @Dr. First Last's comments as well as a prior post on this site in which anecdotes are cited of situations which falsely appeared suggestive of prostate cancer. As contemporary guidelines recommend treatment only in patients with localized prostate cancer with > 5-10 year li...
What is your approach to patients with unresectable, node-negative perihilar cholangiocarcinoma who have undergone biliary stenting and have no evidence of distant disease?
For perihilar cholangiocarcinoma that has been deemed unresectable by hepatobiliary surgeons, a good consideration is to have the patient evaluated for liver transplantation. The Mayo Clinic protocol allows tumor mass of <3cm, no nodal disease, and vascular involvement is allowed. Depending on the f...
How do you time re-staging studies and adjuvant durvalumab for stage III NSCLC treated with definitive cCRT?
In the PACIFIC study, 713 patients who received at least 2 cycles of platinum-based chemotherapy with radiation (CRT) and did not develop disease progression were randomly assigned in a 2:1 manner to receive durvalumab at 10 mg/kg every 2 weeks up to 12 months or placebo. Randomization took place be...
For patients with inoperable stage III NSCLC who are unable to receive or refuse definitive chemoradiation, how do you decide among radiation alone, pembrolizumab alone, or radiation followed by either pembrolizumab or durvalumab?
So, this is a challenging question – actually two questions – 1) unable, 2) refuse. With respect to unable, this typically would (I assume, and in my practice) refer to patients whose functional status is sufficiently poor to prevent one from giving chemotherapy along with radiation. Note that esse...
How do you monitor response for stage III NSCLC patients receiving consolidation immunotherapy?
Generally, the first imaging post chemoradiation (CRT) would have been performed about 6-8 weeks following completion, and this has changed as we start durvalumab within 42 days following CRT. I perform a baseline CT chest prior to starting durvalumab. I proceed to monitor with CT chest about every ...