Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
In women of childbearing age with NMDA encephalitis and normal pelvic imaging, is there a role for oophorectomy for possible microteratoma?
Pelvic imaging of female patients with anti-NMDA-receptor encephalitis for ovarian teratoma should consist of MRI of pelvis or ultrasound of pelvis with transvaginal views. If this testing is unrevealing, the recommendation, in general, is not to proceed with oophorectomy. There have been reports of...
How do you approach a BRCA-mutated, premenopausal woman with metastatic ER+, Her2+ carcinoma with progression on THP?
This is probably not a common scenario, but one that theoretically crosses 3 areas of metastatic disease with largely non overlapping clinical trial data. It is somewhat unusual because premenopausal women with ER-positive/HER2 positive breast cancer have disease that is typically sensitive to estro...
Is there a role for any of the CDK4/6 inhibitors in ER+/HER2+ or ER-/HER2+ metastatic breast cancer?
This question is being addressed in clinical trials of CDK4/6 inhibitors. In preclinical studies, CDK4/6 inhibition induces senescence in HER2 positive breast cancer cell lines and there is synergistic anti-tumor activity with combined HER2 targeted agents and CDK4/6 inhibitors. As a downstream targ...
What frontline therapy would you offer for a patient who is elderly or unfit for standard induction therapy with both IDH-2 and FLT-3 ITD mutations?
For a newly diagnosed patient, unfit for induction chemotherapy with both an IDH2 and FLT3 mutation, I would offer HMA with venetoclax for the initial treatment. While both the IDH2 inhibitor Enasidenib and the FLT3 inhibitor Gilteritinib are both well-tolerated drugs with good remission rates, if y...
What frontline therapy would you offer for a patient who is elderly or unfit for standard induction therapy with both IDH-2 and FLT-3 ITD mutations?
For a newly diagnosed patient, unfit for induction chemotherapy with both an IDH2 and FLT3 mutation, I would offer HMA with venetoclax for the initial treatment. While both the IDH2 inhibitor Enasidenib and the FLT3 inhibitor Gilteritinib are both well-tolerated drugs with good remission rates, if y...
Do you resume zoledronic acid or denosumab at relapse in multiple myeloma?
This is generally a data free zone. Remember at induction, the overall survival benefit with Zometa is ONLY in patients with myeloma bone disease achieving less than a partial response to induction. The skeletal related event (SRE) risk reduction compared to placebo was dependent on myeloma control ...
How would you manage a patient with PV or ET who is experiencing breakthrough thrombosis?
The first question I would ask in this clinical situation is, "does the patient have PV or ET?"; a patient cannot have both. Unfortunately, I encounter this situation too often in my clinical practice. There appears to be a curious but dangerous belief in the medical community that ET is a more sero...
How would you manage a patient with PV or ET who is experiencing breakthrough thrombosis?
The first question I would ask in this clinical situation is, "does the patient have PV or ET?"; a patient cannot have both. Unfortunately, I encounter this situation too often in my clinical practice. There appears to be a curious but dangerous belief in the medical community that ET is a more sero...
What treatment would you provide for a patient with bilateral synchronous locally advanced cT4dN0 TNBC and cT1b ER+ HER2+ breast cancer?
Yes, the TNBC seems to be locally advanced and being T4d, would qualify for the KEYNOTE-522 regimen. The HER-2 positive cancer is small and clinically lymph node negative, so upfront surgery followed by adjuvant anti HER-2 therapy based on APT trial would be reasonable. But since the patient would h...
Would you give anthracycline chemotherapy to a patient with HR+, HER2 negative inflammatory breast cancer who has history of cardiomyopathy with LVH and moderately reduced EF but most recent echo shows improvement to normal or near normal ejection fraction?
This is a tricky one. The main question is not what the current LVEF is, in my opinion. While it is reassuring to have a normal EF, comorbidities and/or prior cardiac disease is where the permanent damage of anthracyclines come into picture. Therefore, how safely can we give anthracycline based regi...