Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Do you routinely offer AR-v7 testing to determine whether to treat with chemotherapy versus enzalutamide or abiraterone in metastatic castration resistant prostate cancer?
The short answer is no, not yet, and not outside of a research study. AR-V7 testing using a CLIA approved circulating tumor cell (CTC) assay, either Qiagen-Hopkins using the Adnatest RT-PCR platform or the EPIC-Genomic Health protein assay, appear very promising as negative predictors of the clinica...
What adjuvant treatment would you recommend for stage III colon cancer in a patient >75yo but with a good performance status?
As is often the case, I'd have to say "it depends". If the patient had stage IIIA disease for which the survival curves are better than IIB and comparable to IIA patients, I'd be inclined to offer capecitabine alone (providing no other poor risk factors such as insufficient nodal count, poorly diffe...
Do you offer somatostatin analogues (eg lanreotide, octreotide) to asymptomatic patients with metastatic, nonfunctioning, well-differentiated enteropancreatic neuroendrocrine tumors?
I do use SSA in non-functional NET because of the clear PFS benefit observed. There is a difference between whether a drug may have OS benefit in a particular setting vs whether it is possible to demonstrate it in a clinical trial. Please see our position paper:Future directions in the treatment of ...
For a patient with metastatic urothelial cancer who has progressed on platinum-based chemotherapy, do you test for tumor PD-L1 expression prior to choosing atezolizumab as second-line treatment?
Currently, atezolizumab is the only drug FDA approved for treatment of patients with metastsatic urothelial cancer progressive despite first-line platinum based chemotherapy. Prior to the approval of atezolizumab, commonly used agents were taxanes or pemetrexed based on small to moderate sized singl...
How would you treat a young man with refractory AML after HIDAC induction who developed cerebellar toxicity to HIDAC and previously received doxorubicin (300 mg/m2) for lymphoma?
CLAG-M (cladribine, Ara-C, mitoxantrone, with G-CSF priming)
Do you routinely include sipuleucel-T as one of your lines of systemic therapy for metastatic castration resistant prostate cancer?
In select patients, I will use Sipuleucel-T as first line therapy for patient with early castrate resistant disease that are asymptomatic. Those that I use Sipuleucel-T I will observe them post therapy unless I see a rapid increase in PSA or other symptoms, then I will start AR directed therapy. Inc...
What is your preferred third-line treatment for a patient with metastatic renal cell carcinoma who has had progression of disease on both initial VEGFR-TKI therapy and second-line nivolumab?
My preferred line treatment is based on the patients initial experience with the 2 prior therapies. If he is a "non-responder" to a VEGF TKI and then nivolumab, my third line choice is then everolimus plus lenvatinib as mTOR inhibition is a novel approach and efficicacy is improved in combination wi...
Which PET imaging modality, if any, is preferred to work up possible nodal involvement or local recurrence in prostate cancer?
In my view, better, more sensitive imaging will transform our management of prostate cancer. Soon, I believe, maybe very soon, we'll be able to detect small volume nodal metastases and small volume metastatic disease. How to manage patients with, say, a solitary, <1 cm lymph node seen on PET will be...
What third and fourth line options do you consider for patients with pleomorphic sarcoma and a good performance status who have progressed on standard anthracycline and gemcitabine/docetaxel?
If the pleomorphic sarcoma is a UPS/MFS - immunotherapy trials would be of interest. As always, any active clinical trials of newer drugs should be considered. SOC alternatives would include Pazopanib. There is also some data (and therefore a broader indication in EU) for trabectedin.
For patients eligible for and considering active surveillance for low-risk prostate cancer, do you routinely use tests for molecular risk stratification?
I have not incorporated genetic testing into my active surveillance strategy. As yet, it is not clear how to use this information to modify the approach to AS. At this point, multi parametric MRI is far more useful, and I recommend this test to all of my patients considering AS to try to rule out th...