Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
In low-risk MDS patients with symptomatic anemia and a low EPO level, how does the presence of a high-frequency SF3B1 mutation influence your first-line choice between an ESA and luspatercept?
I would consider the SF3B1 mutation to be the relevant biomarker for the selection of frontline therapy (namely luspatercept) in this case. The correlation between SF3B1 mutations and the presence of ring sideroblasts in MDS is strong but not perfect. This could be for a variety of reasons, the most...
In low-risk MDS patients with symptomatic anemia and a low EPO level, how does the presence of a high-frequency SF3B1 mutation influence your first-line choice between an ESA and luspatercept?
I would consider the SF3B1 mutation to be the relevant biomarker for the selection of frontline therapy (namely luspatercept) in this case. The correlation between SF3B1 mutations and the presence of ring sideroblasts in MDS is strong but not perfect. This could be for a variety of reasons, the most...
What type of surveillance would you recommend following resection of primary mucinous carcinoma of the skin?
A full skin examination every 6 to 12 months. Reminding the patient to call the clinic immediately for any symptoms that are unusual, or for a new skin lesion and perform a symptoms directed work-up.
What would you offer as adjuvant therapy for a resected stage IIIB adeno NSCLC in a patient who refuses chemotherapy?
Patients with stage III NSCLC are at very high risk for recurrence, and in this situation, I would make sure that your discussions with the patient highlight this clearly. My usual thought is that if a patient can tolerate and recover from lobectomy/resection, then that is a reasonable indication th...
In which patients will you consider a shorter course of adjuvant Herceptin?
At this point, I would not treat any patients with short term trastuzumab. The Short-Her study had very wide confidence intervals for non-inferiority, and there was a numerically superior 2.2% improvement in DFS in the long (standard) trastuzumab arm. Additionally, in the patients with the worst pro...
Does stage of resected EGFRm NSCLC impact your treatment decisions for use of adjuvant osimertinib?
Yes, to some degree; it informs the risk/benefit ratio when I discuss adjuvant osimertinb with patients. The benefit of adjuvant osimertinib was seen in stages 1B, 2 and 3 but the magnitude of the benefit increased with higher stages. This makes sense because the risk of recurrence increases with in...
For a patient with T3N1M0 esophageal adenocarcinoma, who suffered esophageal perforation necessitating metallic stent placement, would you favor a neoadjuvant chemoradiation or perioperative chemotherapy approach?
In situations of esophageal perforation, the main concern will be the dissemination of disease particularly in the thoracic cavity, i.e. pleura. Therefore, I favor a systemic therapy approach upfront. Should the patient have a good response to systemic therapy, then chemoradiation could be considere...
In a patient with a mid-esophageal squamous cell carcinoma with tracheal invasion confirmed on bronchoscopy, would you treat with definitive chemo-radiation with curative intent?
I generally start with chemotherapy alone in these patients, usually carbo/taxol for 2-3 months, and then re-evaluate with PET, bronchoscopy, and endoscopy to determine if there is still evidence of transmural invasion into the trachea. Often, if the tumor responds, the tracheal invasion is no longe...
Would you offer other antibody-drug conjugates to a patient who had a history of G2 trastuzumab deruxtecan-induced pneumonitis that is now resolved?
There are no prospective data to guide this decision; the decision requires careful individualization. TDM-1 (ado-trastuzumab emtansine has a substantially lower pneumonitis risk than trastuzumab deruxtecan (1.6-1.9% with TDM-1 compared to 9.6-10.5% with trastuzumab deruxtecan), and TDM-1 uses a dif...
Do you always send SDHB by IHC for workup of GIST or is NGS that includes SDHB sufficient?
In the appropriate clinical presentation, with negative KIT and PDGFRA, NGS that includes SDH should be sufficient to define the entity.