Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How do you manage anticoagulation/antiplatelet therapies with strong indications for uninterrupted therapy in the setting of urgent procedures?
If anticoagulation is absolutely contraindicated because of the bleeding risk of the procedure, then "bridging" will usually make the most sense, most of the time, with low molecular weight heparin such as enoxaparin. If dual antiplatelet agents are contraindicated, particularly in the first month a...
How do you manage anticoagulation/antiplatelet therapies with strong indications for uninterrupted therapy in the setting of urgent procedures?
If anticoagulation is absolutely contraindicated because of the bleeding risk of the procedure, then "bridging" will usually make the most sense, most of the time, with low molecular weight heparin such as enoxaparin. If dual antiplatelet agents are contraindicated, particularly in the first month a...
In which patients will you consider the use of adjuvant pertuzumab for HER2 positive early stage breast cancer?
The benefit of adding pertuzumab to a trastuzumab-based regimen is quite small (0.9% at 3 years, 1.8% in those with involved LNs). This will not change my practice for most patients. Certainly for a patient with multiple involved nodes and ER- disease, the addition of pertuzumab will become a long d...
Do you recommend MSI testing to any tumor that is not already eligible for immunotherapy?
The accelerated approval of pembrolizumab in MSI-H tumors was based on data from 149 pateints with MSI-H or dMMR cancers from five different single arm studies. Ninety of those patients were colorectal, the remaining 59 were a mix of 14 different types. The ORR for the entire group was almost 40% wi...
What treatment would you offer for patients with metastatic NSCLC (adenocarcinoma) who are EGFR positive AND PD-L1 >50%, who fail first line EGFR therapy (and are negative for T790M mutation)?
There are many clinical trial approaches that are evaluating immunotherapy among patients with EGFR mutations. Yet, there is little data to date of large populations of patients with long lasting responses to single agent PD-1 or PD-L1 inhibitors in the setting of EGFR mutations. Outside of a clinic...
What is your strategy to help prevent paclitaxel-related neuropathy?
There are no proven strategies for prevention of CIPN and the use of these supplements is not recommended. Some supplements such as acetyl carnitine can actually worsen neuropathy outcomes and some supplements such as B12, vitamin C, and others may negatively interact with chemotherapy and worsen di...
What is your approach to TNT sequencing for locally advanced rectal primaries with low volume metastatic disease to liver?
This is a very common clinical scenario for which I'm not aware of a single correct answer. I assume by "low volume" metastatic disease to the liver the question implies potentially curable through some combination of liver-directed therapies. The only part of the sequencing about which I am fairly ...
What experience do you have with paralysis or myasthenia-like symptoms developing on temozolomide?
This is not an established toxicity of temozolomide and would warrant further investigation.
How does genomic profiling/next-generation sequencing assays influence your treatment recommendations in metastatic breast cancer?
At the current time, there are no evidence-based, FDA-approved or NCCN-recommended uses of genomic or protein-based assays other than ER, PR, or HER as well as gene expression profiling results like the 21-gene/Oncotype or 70-gene MammaPrint assay for routine management of breast cancer. There is no...
What is your preferred approach to adjuvant therapy for a Masaoka Stage III thymic carcinoma after R1 resection?
The data for adjuvant treatment of thymic carcinoma is relatively scarce, with most studies and series on this topic have traditionally included all thymic malignancies including thymomas. In the scenario presented in the question, there are multiple risk factors- thymic carcinoma, R1 resection both...