Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How do you counsel women with a history of breast cancer who have dense breasts, with regards to mammography screening?
The question of how best to follow women after treatment for breast cancer is one that is of great concern to oncologists. Many factors play into the type and frequency of screening. However, little definitive data exists showing benefit of anything above annual screening with mammography. For our s...
Do you offer the addition of necitumumab to first-line chemotherapy for patients with advanced/metastatic squamous cell NSCLC?
There are multiple competing therapeutic strategies for patients with advanced stage squamous cell carcinoma Recent data does demonstrate that the addition of necitumumab to cisplatin/gemcitabine improves survival by six weeks when compared to cisplatin/gemcitabine alone (SQUIRE study). The pros of ...
How do you sequence systemic therapies for recurrent/metastatic head/neck cancer following the recent approval of pembrolizumab?
We currently do not have any available predictive biomarker to inform us on which patients will respond to PD-1 inhibitors based on recently presented data. This work remains investigational. Hence, we do not check PD-1 status to determine whether or not patients should receive immunotherapy.
What do you recommend for patients who experience anorexia due to loss of appetite?
"But to eat when you are sick, is to feed your sickness."- Hippocrates A lot of preclinical work (Valter longo, Warburg etc) show he was probably right and the fact that tumors will preferentially have access to gluocse and proteins (ie PET scan-Warburg effect)I would use steroids (dexamethasone or ...
Do you repeat the comprehensive BRCA analysis (like Myriad) in "at risk patients" with a positive family history, who tested negative for BRCA1 and BRCA2 deleterious mutations 10 years ago?
Yes.
How do you treat patients with early-stage ER+/Her2- breast cancer who recur years later after definitive therapy and hormonal therapy?
There's a lot of nuances to this question. What's the disease burden? Is there considerable visceral disease? What is the performance status of the patient? And finally, patient preference? If there is considerable visceral disease, I do consider single agent chemotherapy for a few cycles, and very ...
What is your approach to the initial treatment of metastatic melanoma patients with NRAS mutations?
The incidence of NRAS mutations in the metastatic setting has been reported in up to 15-20% of patients. There are currently no FDA approved agents specifically for NRAS mutated patients who progress after immunotherapy. Some studies have shown these patients may have better responses to first line-...
In what situation would you check receptor status (ER/PR/HER2) on more than one lesion in a multifocal breast cancer?
This is should be performed when there is a discordant response to therapy. For example, a patient with multifocal HER2 positive breast cancer has tumor progression through neoadjuvant HER2 directed therapy, it is reasonable to re-check receptor status. Another instance may be considered when one le...
How are you planning to use Mammaprint for the management of locally advanced ER+ breast cancer at clinical high risk of recurrence based on size and up to 3 lymph nodes?
This is an interesting question. I am going to use Mammaprint in the adjuvant setting for patients with high risk of recurrence for tumors of any size and for 0-3 LN positive. These were the criteria used in the MINDACT study, and the 5 year distant DFS in these patients was 95% with endocrine thera...
For metastatic NSCLC patients who are started on first-line platinum doublet chemotherapy and are subsequently found to have an EGFR exon 19 or 21 driver mutation, do you switch to an EGFR TKI immediately once the mutation is detected or do you wait until progression on chemotherapy?
It depends on the response and toxicity of the chemo. If patient is in first 2 cycles and responding without out much toxicity I complete 4 cycles and then switch more or less as maintenance. If patient is not responding or having unacceptable toxicity, I switch right away. I have two patients on er...