Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How would you approach treatment in a patient with Fanconi anemia and glioblastoma?
This is challenging due to the sensitivity of Fanconi anemia patients to DNA-damaging treatment. I would maximize resection if possible and then treat with radiation, since it is a mainstay of therapy, despite the risk. I would opt for proton radiation if possible to minimize exposure of normal tiss...
Would you offer OFS 5 years out from diagnosis in a young patient whose menses have returned with previously treated IDC?
I would if you are considering extending her endocrine therapy based on clinical risk or other info like BCI testing. If she took tamoxifen alone then I would discuss OFS+AI based on the benefit seen in MA.17 for letrozole x 5 years after tam x 5 years. Shouldn't matter if the menopause is natural o...
What is your frontline treatment of choice for patients with systemic and secondary CNS involvement by DLBCL?
It depends on the intent of treatment, the age, and the PS of the patient. If you are going for a potential curative intent, R-CHOP combined with high-dose methotrexate (R-CHOP-M) - Damaj et al., PMID 26185174, followed by thiotepa-based (thiotepa-BCNU) autoSCT in young, fit patients with chemorespo...
In patients with HTLV-1 associated acute T-cell leukemia, is there any clear benefit of adding antivirals?
There is no virologic rationale for using antivirals to treat HTLV-1-associated malignancies. HTLV-1 is a "transforming" retrovirus that directly causes cancer by oncogene expression. There is no significant "lytic" replication occurring once the cancer has manifested. Antiretrovirals only work with...
What is the appropriate treatment for marginal zone lymphoma of the parotid following surgery?
Definitive radiation therapy is the standard treatment for a patient with an uncomplicated case of localized marginal zone lymphoma of the parotid gland. The CTV would encompass the entire gland and the total dose would be 24 Gy. Occasionally patients will be diagnosed with MZL after parotidectomy, ...
Do you prefer cisplatin or carboplatin in combination with nivolumab per CheckMate 816 for patients with resectable NSCLC?
As a survivor of the cisplatin/carboplatin (i.e., coke/pepsi) wars, I hesitate to jump into this question. I note that in the referenced study (CM 816 Forde et al., PMID 35403841), 72% of the patients received cisplatin based chemotherapy preoperatively, and 28% received carboplatin based preop chem...
Would you prefer nivolumab/ipilimumab combination over single agent pembrolizumab for a metachronous low volume MSI-H, metastatic colon cancer, with KRAS mutation?
To date, I don't think there are any single negative or positive predictive markers of response to immunotherapy in dMMR/MSI-High.The ones identified retrospectively on subset analyses include KRAS as you mentioned Other studies with BRAF, Or liver metastatic disease Elderly However, my take/experi...
How do you initially treat patients with cN3 cM0 esophageal cancer?
This is an extremely heterogenous group and requires expert multidisciplinary review to generate an individualized plan. In fact, we discussed several patients with N3 disease -- very extensive but technically locoregional lymphadenopathy -- at our Disease Management Team meeting yesterday morning.O...
For a patient requiring adjuvant endocrine therapy for localized breast cancer, would you use fulvestrant if they were intolerant to both aromatase inhibitor and tamoxifen?
I think you may run into coverage issues since fulvestrant is not approved for the treatment of early breast cancer. For patients who don't tolerate AI or tamoxifen, I normally try Fareston (toremifene). I have a small handful of patients in my panel that have tolerated that when they haven't tolera...
Would you consider trastuzumab deruxtecan as next line of therapy for patients with ERBB2 mutation positive, stage IIIB NSCLC, who progress within 6 months of chemo- radiation?
Yes, I would consider trastuzumab deruxtecan as the next line of therapy for patients with ERBB2 mutation-positive, stage IIIB NSCLC, who progress within 6 months of chemo-radiation. We typically use recurrence within one year as the time frame between completion of chemo-radiation and recurrence fo...