Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
In light of the 2 negative bevacizumab trials for up-front GBM, how do you feel about the future of bevacizumab in GBM?
At the 2010 ASTRO meeting, Dr Inder Verma of the Salk Institute gave a very nice keynote address talking about his work using a mouse model of GBM where the GBM cells themselves can morph into vessels as needed, with no expectation of response to anti-VEGF therapy. The work was published a while bac...
What is your approach for a locally advanced (stage IVA secondary to N2 disease in the neck), HPV-negative, squamous cell carcinoma of the base of tongue in a patient without significant comorbidities?
In short, we usually do definitive chemorads. However, this question is more complicated than it seems. With TORS/TLM, surgery seems an option for early Tstage disease, as it is in HPV +ve disease. I believe one of the national studies will try to address this question.For more advanced T-stage, Eve...
Do you give chemotherapy for focal triple negative breast cancer?
not if DCIS with micro invasion.. what is the size of invasive component??
When do you recommend consolidative XRT for patients with advanced stage (III-IV) DLBCL who achieve CR to chemoimmunotherapy?
The cornerstone of therapy for advanced DLBCL is chemoimmunotherapy (R-CHOP). Efforts to improve upon this with systemic therapy have been largely unsuccessful (dose-dense chemotherapy, maintenance R, more intensive chemotherapy, high-dose chemotherapy and autologous SCT, etc.). There are increasing...
Is it safe to offer breast/chest wall radiotherapy while a patient is receiving Perjeta?
The question of concurrent pertuzumab and radiation in the palliative setting will likely come up more often now with the recent striking improvement in overall survival of 15.7 months in stage IV HER2+ patients treated with docetaxel pertuzumab and trastuzumab as compared with docetaxel and hercept...
Should early referral to palliative care be standard of care for all patients with metastatic cancer?
There are data to support that early palliative care involvement can improve patient quality of life. One study that specifically comes to mind is a study published by Temel et al in NEJM 2010 (http://www.ncbi.nlm.nih.gov/pubmed/20818875) in the setting of metastatic NSCLC. This study randomized pat...
What is the role of radiation consolidation after chemotherapy for residual splenic involvement in follicular lymphoma?
Recommend 3000 cGy in 15 fractions
Is there a role for anti PD-1/checkpoint inhibitors or other immunotherapies with radiation?
There's a lot of enthusiasm, and fairly little evidence so far. Driving the interest is the observation made over the past several decades, that radiation can induce an immunologic/abscopal response: that by treating one site of disease, a systemic response is initiated that results in responses in ...
In which patients with early-stage favorable Hodgkin's lymphoma, if any, would you consider omitting consolidation RT after ABVD chemotherapy?
The GHSG HD16 randomized trial was recently reported at ASH (Abstract 925). Patients with early-stage, favorable HL (per GHSG criteria) were randomized to standard treatment (ABVD X 2 followed by 20 Gy of RT) or a PET-directed approach. If PET negative after 2 cycles (defined as Deauville 1-2), then...
Do you recommend breast MRI for patients with invasive lobular breast cancer considering breast conservation therapy?
I agree with @Dr. First Last. I used to get MRIs in women with lobular cancers routinely, but as data have shown no outcome benefit to pre-op MRI and a higher mastectomy rate associated with the use of MRI, I now only get MRIs in patients in whom the surgeon feels that the other imaging is too equiv...