Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Would you offer adjuvant immune checkpoint therapy for a patient with resected mucosal melanoma with a tumor thickness >4.0 mm with negative LN involvement?
Although adjuvant therapy is an option for patients with thick cutaneous melanomas, based on the results of the KEYNOTE-716 clinical trial (as well as CheckMate76K clinical trials), these trials limited accruals to cutaneous melanoma patients only. Thus, the efficacy of adjuvant immune checkpoint th...
Would you offer adjuvant immunotherapy to patients with stage II-III NSCLC who achieved a pathologic complete response from 3 cycles of neoadjuvant nivolumab + chemotherapy?
Approximately, 1/4 (24%) of patients in the CheckMate 816 trial treated with nivolumab + chemotherapy achieved a pathologic CR (compared to 2% with neoadjuvant chemo alone). The patients who did achieve a pathCR had the best EFS (although limited follow up to date; median EFS not reached, HR 0.13). ...
How would you treat bilateral synchronous breast cancer with single bony metastatic disease on imaging when one is ER+ HER2 neg and other is TNBC?
I will make some general statements, but lots of "depends" that you, the patient, and your team must discuss and decide. Firstly, it is important to biopsy this single site to determine which breast cancer has metastasized. It is also important to recognize that although you see "a single bony metas...
Do you recommend prophylactic anticoagulation to pregnant women undergoing chemotherapy for breast cancer?
It is a very interesting thought but no, to my knowledge, there is no data to support anticoagulation of pregnant women receiving chemotherapy for breast cancer, and it is not a standard practice nor is it part of the guidelines around treating breast cancer in pregnancy.
What is your systemic therapy of choice for patients with metastatic small cell carcinoma of breast origin?
The first thing I do is to discuss with a pathologist given how rare this type of breast cancer is. If the patient is referred from another institution, I request the slides and place a second opinion in pathology. If this is truly a small-cell carcinoma of breast, I would use small-cell carcinoma-s...
How would you approach treatment of metastatic signet cell carcinoma of likely gastrointestinal origin with no primary lesion identified?
I would typically like more information before proceeding. With advanced diagnostics, we have seen the incidence of CUPs fall in recent years but that said, the true CUP still exists.When stated this is "likely GI origin", I assume that there are IHC features consistent with GI origin such as CK7+ b...
How long do you continue treatment with imatinib in a patient with chronic eosinophilic leukemia who achieves remission?
This has not been clearly established. If the patient has the FIP1L1/PDGFR rearrangement, these patients need very low doses for excellent response, typically 100 mg daily. If not, response rates are lower and they usually require higher doses. I would continue therapy indefinitely as TFR has not be...
Do you switch from imatinib to another TKI in patients with chronic phase CML who develop renal insufficiency?
Imatinib has been associated with a decline in GFR. It is not certain (and probably doubtful) that this represents kidney damage. If no other causes can be identified, a change could be appropriate. Bosutinib has been associated with a similar decline so nilotinib or dasatinib might be better option...
How would the development of pneumonitis from pembrolizumab after treatment as per Keynote 522 alter your PMRT recommendations?
If recovered completely, I would proceed with PMRT.
Do you always obtain PSMA PET as initial staging for high risk and very high risk localized prostate cancer patients?
I do obtain a PSMA PET/CT or PET/MRI in all patients with high risk localized prostate cancer. However, when this is not available due to insurance coverage issues or lack of access to PSMA PET, it is still acceptable to stage with bone scan and CT or MRI. I prefer PSMA PET because it has better per...