Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How do you manage aromatase inhibitor- associated musculoskeletal syndrome (AIMSS) symptoms in post-menopausal breast cancer patients?
Available published data suggests that switching from one AI to another, does help to reduce AIMSS. This strategy is associated with improvement in AIMSS about 50% of the time (in published literature). From personal experience, letrozole tends to cause the most symptoms since from pharmacologic sta...
How do you decide when to refer a patient with metastatic renal cell carcinoma for cytoreductive nephrectomy?
Although dated, two large randomized trials showed a nearly 6 month OS advantage with debulking nephrectomy in the cytokine era, and thus my opinoin is that debulking nephrectomy is the standard of care in appropriately selected patients. The phase 3 data and modern retrospective analyses in the TKI...
For women with metastatic HER2 + breast cancer who achieve a complete response, how long do you continue on HER2-directed therapies?
In nearly all cases, I would continue therapy until progression or unacceptable toxicity. Multiple studies have found an improvement in PFS and.or OS by continuing trastuzumab (or other HER2 inhibitor) after progression on trastuzumab.. Ask yourself this.....if continuing BEYOND progression is helpf...
Which, if any, aspects of your management of prostate cancer differ in your African-American patients versus those of other racial/ethnic backgrounds?
My short answer is that I do not treat patients diagnosed with prostate cancer differently based on race or ethnicity. There is data to support a higher risk of progression on active surveillance among African American men as compared with Caucasian American men with low risk prostate cancer, but th...
How would you approach a patient with node positive triple-negative breast cancer during her first trimester of pregnancy?
Most patients with triple negative breast cancer will benefit from adjuvant chemotherapy either given before or after surgery to lower the risk of recurrence and mortality. Certain types of chemotherapy, notably doxorubicin and cyclophosphamide (AC) can be relatively safely administered during pregn...
For patients with advanced NSCLC who have radiographic disease progression on their follow-up scan after starting a PD-1 inhibitor, what characteristics (either clinical or radiographic) do you use to determine whether to continue with therapy or switch to something else?
I agree with @Dr. First Last - there are two situations in which I would consider continuing therapy for another 4 or 6 weeks, 1) if as he has noted, there is some inconsistency (ie some areas worse and some better) AND the patient is feeling well, 2) if there is modest radiographic progression BUT ...
For recurrent prostate cancer after definitive radiation, how do you guide patients between the various salvage options vs ADT?
This is a complex clinical situation and one needs to incorporate all available evidence regarding prior XRT details and PSA trajectory and imaging workup into the treatment decision. Below is the general strategy we use at Emory: For patients with rising PSA's post XRT, one should do a DRE, bone s...
In a patient with ER+/HER2- breast cancer, do you ever use Oncotype testing to assist in decision-making regarding adjuvant chemotherapy when the tumor size is less than 0.5 cm, or when there are positive lymph nodes?
The NSABP and other data that was approved for prognostication and for prediction of benefit with chemo excluded 5 mm or smaller tumors. In practice, oncologists would not offer chemo for ER positive and node negative tumors that are 5 mm or less in size . Thus, I would not do oncotype do testing. B...
Do you ever use bevacizumab in combination with standard radiation and temozolomide in the first-line setting for patients with glioblastoma?
Two clinical trials (AVAGLIO and RTOG 0825) used bevacizumab (Avastin) along with standard temozolomide and radiation therapy for newly diagnosed glioblastoma. While they did not see improved OS, they did see improved PFS. In an evaluation of AVAGLIO, for those patients who did not go on to receive ...
Do you routinely use tumor lysis prophylaxis when starting chemotherapy for germ cell tumors?
THere is not reason to use tumor lysis prophylaxis. Hydration of course is required for the cisplatin. I am not aware of anyone using allopurinol or other TLS approaches