Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How would you treat a patient with T1c HR-, HER2+ breast cancer, stage IV, with involvement of multiple bilateral axillary nodes and no evidence of distant metastasis?
Assuming biopsy proven disease in both axilla, would favor treating with definitive intent with TCHP followed by surgery (nodal surgery extent based on response to chemo) followed by RT.
How do you approach patients with recurrent papillary thyroid cancer following thyroidectomy who now has palpable cervical nodes and underwent neck dissection and RAI?
It would be helpful to know when total thyroidectomy was done and if there was I-131 uptake on pre- and post- I-131 treatment? When was the RAI treatment? Is the thyroglobulin rising? Typically, if this is happening several months after RAI treatment, I would biopsy the node to make sure it is not d...
When would you ever consider lifelong imatinib in adjuvant therapy for GIST?
The risk of recurrence and mutational status are important tumor related factors. Combine that with host factors including risk tolerance and physical drug tolerance helps with the conversation to reach a unanimous decision.
Would you ever use a PET dotatate CT to monitor response of a GEP-NEN that is SSTR positive?
I would use baseline PET/CT or PET/MR and then subsequent scans would be with cross-sectional imaging with CTs or MRIs (MRI EOVIST if the liver is involved). CTs and MRIs would give a much better assessment of sizes for the established lesions.
How would you approach a postmenopausal patient on Letrozole who developed cataracts within the first six months of treatment?
While tamoxifen has been associated with ocular toxicity like cataracts, there has not been any conclusive or convincing connection between aromatase inhibitors and cataracts. Since the alternative to aromatase inhibitors is tamoxifen which we know may be associated with cataracts, and given the la...
Is there a role for further HER2 directed therapies after progression on fam-trastuzumab deruxtecan after a sustained initial response in patients with metastatic HER2+ colorectal cancer?
Great question, but no data (yet).The Destiny-CRC 01 study enrolled 16 patients (out of 86, 18.6%) who had previous anti-HER2 agents. All these 16 patients were in Cohort A which is HER3 IHC 3+ or IHC2+/ISH+ (total of 53 patients). In the subgroup analysis, median progression-free survival was simil...
Would you consider ALK-directed TKI for a ALK L1198F point mutation in a patient with metastatic lung adenocarcinoma after progressing through first line chemoimmunotherapy?
I would not because de novo ALK point mutations are rarely sensitizing in lung cancer. This specific mutation has been described in anaplastic thyroid cancer. From this question, it is not clear if this patient (1) had an underlying ALK rearrangement (which is the alteration we predict would be acti...
Would you consider reserving enfortumab + pembrolizumab combination as second line after progression post platinum-based chemotherapy?
In urothelial cancer, as in most metastatic solid tumors, your optimal outcome comes from up front therapy, "saving things for later" is not usually the best management approach. As noted by the good Dr. @Dr. First Last, given the info we have regarding EV 302 (press release), this regimen may becom...
What is the role for molecular agents alone for medically inoperable NSCLC who is not a good candidate for chemoRT?
If medically inoperable and deemed not a chemo candidate, my preference would be definitive RT alone using a hypofractionated approach to account for the absence of radiosensitizing chemotherapy even for patients with targetable driver mutations. The best data we currently have would then say to con...
What is your approach to bridging anticoagulation in patients with history of recent HIT?
One should not re-expose patients with past HIT to heparins. Even with remote HIT, there is a high rate of serologic recurrence (eg, Warkentin and Anderson, PMID 27114458) and while the rate of overt HIT relapse may be low with proper precautions, I have seen and published a couple of fatal HIT recu...