Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
In light of the recent results from STAMPEDE and LATITUDE, to which patients with newly diagnosed metastatic prostate cancer are you offering up-front abiraterone vs. up-front docetaxel?
Although I anticipate that the Stampede investigators will publish (an underpowered) comparison of their ADT plus docetaxel arm vs ADT plus abiraterone which may provide some insight, for the most part we will be in a data free zone re: this issue for some time. I suspect that clinicians will contin...
Would you use bone marrow MRD status to guide stopping daratumumab early at 1 year instead of the recommended 3 years of therapy per the AQUILA trial for high-risk smoldering myeloma?
I would venture to say that there is probably a 0% chance that MRD negativity would be achieved with daratumumab alone. The CR rate was 8.8%, but MRD was not assessed, and I would doubt that MRD negativity was achieved in any patient. That said, we can't really extrapolate whether 1 year and stoppin...
Would you use bone marrow MRD status to guide stopping daratumumab early at 1 year instead of the recommended 3 years of therapy per the AQUILA trial for high-risk smoldering myeloma?
I would venture to say that there is probably a 0% chance that MRD negativity would be achieved with daratumumab alone. The CR rate was 8.8%, but MRD was not assessed, and I would doubt that MRD negativity was achieved in any patient. That said, we can't really extrapolate whether 1 year and stoppin...
In patients with advanced endometrial cancer who you plan to treat with chemotherapy + immunotherapy (per GY018 or RUBY), how and when do you utilize adjuvant EBRT and/or brachytherapy?
Reading the question at face value - does advanced endometrial cancer mean stage IVB? III/IVA? If IVB, there is not routinely a role of 'adjuvant' EBRT or BT.Given the discussion of adjuvant therapy, I presume the question is asking for the small fraction of RUBY and GY-018 patients who were stage I...
How do you counsel your breast-cancer survivors about weight-loss/dietary modifications?
Normal body mass index (BMI) and maintenance of weight is associated with a more favorable outcome (in many series both cancer-related and non-related) compared to higher BMI. Similarly higher level of exercise and metabolic equivalent (MET) is also associated with better outcome in many observation...
When would you recommend abiraterone concurrently with RT for high-risk prostate cancer?
The trial got published in NEJM. It confirms survival advantage and skeletal mets advantage with abiraterone for metastatic disease similar to the Latitude study. This will certainly be an option for metastatic disease at presentation (along with docetaxel until comparative studies comparing docetax...
When do you choose a non-anthracycline containing regimen, such as docetaxel/cyclophosphamide, for patients with hormone receptor positive, HER2 negative breast cancer who warrant adjuvant chemotherapy?
As in many of the decisions we face, we need to balance benefit and risk. Based on the ABC suite of trials, anthracycline regimens are slightly more effective than non-anthracycline (taxane only) regimens. To be clear, the ABC data is far from perfect - the trial design changed at least 3 times duri...
What radiation dose do you typically use for relapsed DLBCL following 6 cycles of R-CHOP?
There are several potential scenarios, all with different answers, so I will illustrate a few.Historically, second-line chemotherapy (e.g., R-ICE) would first be pursued for relapsed DLBCL, and if the disease was still responsive to chemotherapy (CR or PR), then the patient would proceed with high-d...
How do you treat newly diagnosed low volume metastatic hormone sensitive prostate cancer in light of new data from STAMPEDE presented at ESMO 2018?
In the prespecified subset of men with mHSPC and low volume of metastases (CHAARTED criteria of 4 or fewer bone metastases and no visceral metastases), there was a 32% improvement in overall survival (HR 0.68 95% CI 0.52-0.9) which was statistically significant and is clinically significant. Given t...
Given results of the IDEA study presented at ASCO, would you consider truncating adjuvant therapy with stage II colon cancer?
The question asked is how one would consider incorporating the recent findings from the IDEA study into the utilization of adjuvant chemotherapy for patients with stage II colon cancer. The findings from this landmark study indicated that under certain circumstances, specifically those of patients w...