Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Do the results of CheckMate 451 (nivo-ipi or nivo maintenance after chemotherapy in patients with SCLC) raise any questions for you about the role of immunotherapy in SCLC as established by the CASPIAN and IMpower 133 trials?
The results of the Checkmate 451 trial evaluating nivolumab and ipilimumab or nivolumab maintenance versus no maintenance following front line chemotherapy for extensive stage small cell lung cancer help put the CASPIAN and IMpower 133 trials using front line chemotherapy with immune checkpoint inhi...
Do you get routine MRI brain for surveillance on patients with history of stage III melanoma?
Unfortunately, this is an area that doesn't have a lot of data to support recommendations. It is rare to develop CNS/brain metastasis as the only site of metastatic disease (~5% of metastatic patients). Therefore, I try to get an annual MRI brain for stage IIIB-IIID (resected) patients, especially i...
How do you manage steroid-refractory acute GVHD following allogeneic transplant?
The short answer is to enroll the patient in a well-designed clinical trial, if available. If not, I would start with ruxolitinib based on the REACH2 trial (Zeiser et al., PMID 32320566) which was multicenter, randomized, open-label, phase 3 trial comparing the efficacy and safety of oral ruxolitini...
How do you manage steroid-refractory acute GVHD following allogeneic transplant?
The short answer is to enroll the patient in a well-designed clinical trial, if available. If not, I would start with ruxolitinib based on the REACH2 trial (Zeiser et al., PMID 32320566) which was multicenter, randomized, open-label, phase 3 trial comparing the efficacy and safety of oral ruxolitini...
Can you safely proceed with breast irradiation during treatment with immunotherapy?
In KEYNOTE-522, RT was done with concurrent Pembro after NACT plus IO and no significant additional untoward effect was reported. So, we do RT routinely with Pembro for these patients.
What would be your regimen of choice for a healthy 80+ year old with localized triple negative breast cancer?
My inclination would be to avoid administering an anthracycline to such a patient, as long as you include a taxane and carboplatin in her treatment regimen. If you're treating her in the neoadjuvant setting, Sharma and colleagues achieved a similar pCR rate with every 3-week docetaxel and carboplati...
Do you try to incorporate mFOLFIRINOX in total neoadjuvant therapy for rectal cancer?
PRODIGE 23 study is an open-label, randomized phase 3 study (Conroy et al., PMID 33862000). Locally advanced rectal cancer patients (cT3 or cT4 M0) were randomized to either the study arm (mFOLFIRINOX X 3 months, chemoradiation, TME, FOLFOX X 3 months) or the standard arm (chemoradiation followed by...
For multiple myeloma, is 8 Gy in 1 fraction an appropriate palliative dose, although this histology was excluded from trials examining a single fraction?
There was a randomized trial comparing 8 Gy/1 fx vs 30 Gy/10 fx for patients with multiple myeloma. There was no difference in analgesic response or recalcification, however patients with the protracted regimen seemed to have a benefit in terms of QOL. However, the the control arm (30 Gy in 10), th...
Would you recommend stent placement upfront in a patient with cervical esophageal cancer and a TE fistula?
Malignant TE fistula is a complex problem which is often associated with a poor prognosis. Palliation with stenting can be problematic as the stent can erode and make the fistula larger. This is especially problematic with "kissing" stents in both the esophagus and the airway and/or in the setting o...
Would you start anticoagulation in a patient with a history of CVA 1 year ago and high risk APL profile who was never started on anticoagulation, but is now presenting for follow up and without recurrent thrombotic events?
This is a difficult question. The details here are important. Therapeutically, you can go either way in my opinion. Were the positive antiphospholipid antibodies checked again later? Did the patient have an infection when the APS labs were first done? Does the patient have diabetes or other CV risk ...