Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Would you recommend nivo/ipi instead of chemotherapy/nivo or chemotherapy alone in advanced squamous esophageal cancer based on Checkmate 648?
How would you approach a patient whose stage II TNBC tumor is visibly progressing on the KN-522 neoadjuvant regimen?
Yes, in a patient whose TNBC is visibly progressing on neoadjuvant chemotherapy, I would change course by either changing regimen or proceeding with local management. The CR rate to the KEYNOTE 522 regimen is impressive (64.8% with pembo vs 51.2% without pembro; Schmid et al., PMID 32101663), but th...
What adjuvant therapy would you offer a TNBC patient with residual disease after receiving the neoadjuvant KEYNOTE-522 regimen?
Safety is pembro and cape was provided in phase I trials. Risk and benefit weighing is important when discussing with patients.
Would you change treatment in a patient with metastatic CRPC on PARP inhibitor with rising PSA but negative Axumin PET scan?
Short Answer: No Medium Answer: The surrogacy of PSA as an intermediate endpoint in both localized prostate cancer and metastatic prostate cancer has been problematic. Multiple variations have been explored and tested including PSA doubling time (PSADT), PSA nadir, absolute PSA level, etc. None have...
What are your considerations for choice of immunotherapy agent with patients with metastatic pMMR HER2- esophageal/GEJ/gastric adenocarcinoma with CPS >=10?
I alluded to this earlier. Although both CheckMate 649 and KEYNOTE 590 included esophageal cancer, there were caveats. Specifically, in CheckMate 649, there were relatively few patients with esophageal adenocarcinoma. The positive results of CM-649 were clearly driven by gastric adenocarcinoma, part...
What are your top takeaways from ASCO GI 2022?
1. "NEONIPIGA” GERCOR: While small numbers of patients, they evaluated an immunotherapy combination in MSI-H locally advanced gastric or GE junction cancer. They demonstrated high rates of responses and 59% path CR which is unprecedented in patients undergoing surgery. It raises the question of whet...
How would treat recurrent, unresectable thymoma in patients treated previously with CAP and radiation therapy with long interval to recurrence (>2 years)?
There are a host of single agents that have activity in thymoma, but unfortunately, none are curative. As such, my approach is to use single agents one at a time to create a more durable chronic disease and to minimize toxicity that is often seen with combination therapy. So drugs with activity incl...
How do you adjust Tamoxifen use in HR+ patients with a history of gastric bypass?
No. I do not track levels of tamoxifen in patients who have had gastric bypass. Though I acknowledge that there are reports of tamoxifen being less absorbed in patients after gastric bypass (Willis et al., PMID 20099995), the therapeutic window for tamoxifen is very wide and recurrence after weight ...
What adjuvant systemic therapy would you recommend for a woman s/p ALND for a nodal recurrence of ER-/HER2+ breast cancer 1 year after completing adjuvant therapy with paclitaxel/trastuzumab for her initial disease?
If the axillary nodes were already dissected, I would try TCHP followed by HP since she is pertuzumab naive and she had a DFI of >12 months from paclitaxel. If she had her nodes clipped for neoadjuvant TCHP, I would have switched to adjuvant TDM1 if she had residual disease in the axillary nodes.
How would you treat a patient with pT1b/T2 adenocarcinoma of mid esophagus with residual cancer after endoscopic resection and who is a poor surgical candidate?
I agree completely with @Dr. First Last.Here’s a multi-institutional series suggesting 3-year OS and PFS of 80% and 60% amongst a predominately elderly, high comorbidity, T1bN0 distal esophagus/GEJ adenocarcinoma cohort who received definitive chemoradiation (Deng et al., PMID 33083658).If the patie...