Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Would you offer adjuvant pembrolizumab to a stage II-III adenocarcinoma of the lung who had a complete pathologic response to 4 cycles of cisplatin/pemetrexed/pembro (KN-671)?
The question posed is a central question of investigation and debate today.In my view, the patients most likely to derive benefit from adjuvant immunotherapy after receiving neo-adjuvant chemo-immunotherapy are those with the best responses to neo-adjuvant therapy. The patients I would least likely ...
Do you consider ablative radiation therapy for oligometastatic colon cancer with 5 pulmonary lesions responding to chemotherapy?
The definition of oligometastatic colorectal cancer (OCRC) varies quite significantly. The European Society for Medical Oncology (ESMO) defines OCRC as having up to five lesions in no more than three metastatic sites but can sometimes have more if complete eradication is possible. There is no random...
Would you consider adjuvant TDM-1 for a patient with HR+,HER2+ breast cancer with pCR in the breast but N1mic disease post neoaduvant chemotherapy?
The Katherine Trial (NEJM 2019:380;617-280) was a randomized trial of trastuzumab emtansine (TDM-1) versus trastuzumab for patients with residual disease after HER2-directed neoadjuvant treatment. The trial was positive for TDM-1. The randomized patients included those with residual invasive disease...
For pre-menopausal patients with high-risk ER+ disease, and who desire pregnancy, what is the best time frame to pause endocrine therapy to allow for pregnancy?
Evidence suggests that pregnancy after a breast cancer diagnosis, even among women with hormone positive tumors, does not increase the risk of recurrence, however this has not been prospectively studied. Current guidelines suggest waiting 2 years, however this is based on retrospective data, that is...
Do you offer memantine for patients undergoing PCI?
Extrapalating on 0614, I do use memantine for patients undergoing PCI. I do this for 6 months. These are patients that are expected to live even longer than brain met patients. And given the low toxicity, I think it would be rude not too (as one of my former students would say!)
When would you recommend adjuvant radiation therapy for a patient with a completely resected (negative margins) dermatofibrosarcoma protuberans?
Agree, we usually do not. Especially if these patients are completely cleared with Mohs surgery, which is found to have lower recurrence rates than WLE.
How do you manage hemophilia A carriers with no history of bleeding complications but with mildly low factor VIII activity (6-40%)?
This is a wide range, if no history of bleeding then do not need factor on a regular basis. But for invasive procedures/surgery/trauma depending on what their levels are at baseline and the bleeding risk of the procedure, you will need to use factor 8, antifibrinolytic agents, or DDAVP. Same about t...
When would you consider using G-CSF in patients with rheumatic disease who have received cyclophosphamide?
Our primary concern would be our patients with systemic lupus erythematosus. There are reports of severe flares in SLE patients treated with G-CSF (vasculitis and nephritis; Vasiliu et al, PMID 16832843) and even reports of cardiac arrest (Ragsdale & Hall Zimmerman, PMID 34748466).Of course, this ne...
Will prior novel hormonal therapy affect when/how you use olaparib plus abiraterone for patients with BRCA-mutated metastatic castration resistant prostate cancer?
Yes, there is no clear data at this time that an AR/PARP inhibitor combination prolongs rPFS or OS in men with mCRPC who have progressed on a prior potent AR inhibitor, as largely these men were excluded or not included in PROpel, MAGNITUDE, or TALAPRO-2. For patients who develop mCRPC but have not ...
Would you offer adjuvant immunotherapy in an elderly patient with stage IIB desmoplastic melanoma post resection with underlying autoimmune disease?
As discussed with our desmoplastic melanoma expert at The Ohio State University, Kari L. Kendra, MD - "Because some patients are potentially "cured" with surgical resection alone and this patient has an autoimmune disease, would not treat in the adjuvant setting. If there is local recurrence, would ...