Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Would you offer neoadjuvant chemotherapy for a large, but recurrent grade 1-2 myxoid chondrosarcoma of knee which is no longer amenable to limb salvage?
While not directly relevant for this patient, it is also important to keep in mind that RT is quite effective in decreasing LF in chondrosarcoma, particularly in anatomically challenging locations like joints/pelvis/spine where wide margins often cannot be achieved. The benefit of RT (HR 0.23 for LF...
In a patient who experienced less than 90% necrosis after neoadjuvant chemotherapy for localized, high-grade osteosarcoma, do you recommend adjuvant ifosfamide?
What is the best way to approach elevated liver enzymes in patients treated with combination TKI and immunotherapy?
We rely on clinical judgment in this case as both TKIs and immunotherapies can cause elevation of liver enzymes. Currently, the recommendations in case the attribution of the hepatitis is questionable is to hold both drugs and to check the liver enzymes daily; if it improves, then it is likely due t...
How would you treat high risk prostate adenocarcinoma who relapsed after RT and ADT with a very low PSA, widespread mets to bone and soft tissue who is progressing on ADT, docetaxel and carboplatin?
Difficult situation, this patient likely has neuroendocrine differentiation. I would check for markers like NSE, chromogranin if positive, then can make the case of treating as small cell ca progressed on platinum based chemotherapy and treat with lurbinectedin (Trigo et al., PMID 32224306).PSMA bas...
How and when are you using sipuleucel-T in metastatic prostate cancer given the increase in available treatment options?
At the present time, they do not. The options of treatment in the mHSPC setting include ADT, NHT, and docetaxel only. There are some ongoing clinical trials evaluating the combination of immune therapy with PD-1/PD-L1 checkpoint inhibitors and docetaxel or NHTs currently. Some phase II clinical tria...
Can you use other iron formulations if a patient develops Stevens-Johnson Syndrome with ferumoxytol?
I have never seen it in tens of thousands of doses so it is difficult to answer. If this is actually real, it must be due to CHO component and not Fe (that would be awful). I would use another formulation and premedicate with steroid and H2 blocker before. Do not use antihistamine.
What is the role of preoperative radiation in patients with bone metastases needing surgical stabilization (ie. ORIF), but without tumor resection?
It depends on the patient’s primary diagnosis, extent of disease (multiple metastases vs oligometastastes), and life expectancy. These factors help us formulate a treatment plan on whether we are going to deliver higher ablative doses for patients with longer life expectancy where the ultimate aim i...
What is the preferred adjuvant therapy for high-risk non-clear cell RCC?
Unfortunately, non-clear cell RCC (nccRCC) has not been included in past or current adjuvant trials. Sunitinib, which has limited effect in the adjuvant setting, would be expected to have even less in nccRCC given relative activity in the metastatic setting. A similar scenario exists for IO adjuvant...
How would you approach therapy for a patient with high-grade sarcoma who is unable to tolerate systemic cytotoxic chemotherapy, but whose tumor revealed NRAS G12A, BRCA1, and MET amplification?
I would try weekly cisplatin. Cisplatin is the best drug there is vs tumors with BRCA1 polymorphisms. You need reasonable kidney function for cisplatin but bad liver does not mean bad kidneys. Platinum is safe, with less hematologic toxicity than other chemos. You don't need a port. Weekly cisplatin...
Would you consider adding HER2 targeted treatment to chemotherapy for a patient with locally advanced, HER2+ rectal cancer who is going to have total neoadjuvant treatment?
There are approximately 3-5% metastatic colorectal cancer patients who have HER2 amplification detected by either IHC, FISH, or by NGS that includes an RNA test (Loree et al., PMID 29718453).Clinical trials showed convincing evidence that HER2 targeted treatment is effective for HER2 positive metast...