Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
When do you change treatment for an asymptomatic metastatic melanoma with a mixed response after at least 3 months of treatment with a PD-L1 inhibitor?
I would continue this patient on immunotherapy for another 3 months, or until the patient is symptomatic due to the progressing tumor. Delayed responses to I/O therapy do occur in about 10% of patients, so this gives the patient the benefit of doubt.
Would you offer immunotherapy first line for patients with adrenocortical carcinoma outside of a clinical trial?
I have not been using ICI as first-line therapy for ACC unless there are concerns for tolerability to EDP. We also do usually not include mitotane in EDP in patients with nonfunctional ACCs. Given the somewhat promising activity of pembrolizumab in ACC, it is a very reasonable second-line choice as ...
How do you factor time from past cytotoxic chemotherapy exposure into diagnosing therapy-related AML?
The WHO criteria do not specify a defined time criteria for the diagnosis of therapy-related AML. WHO writes, "Most cases of t-AML present within 10 years of the most recent exposure, and the origin of AML in cases with very long latent periods may be unrelated to therapy." But even if a patient pre...
What upfront maintenance therapy would you recommend for a BRCA negative, advanced epithelial ovarian cancer patient after completing adjuvant carboplatin, paclitaxel, bevacizumab?
Without knowing the somatic genetics, I’d recommend niraparib. If she was BRCA+ or HRD+ by somatic testing, I’d consider Olaparib plus bevacizumab.
Would you offer concurrent chemoradiotherapy and/or adjuvant systemic therapy (chemo or immunotherapy) or for a completely resected stage III Merkel cell after WLE and ALND?
One would potentially extrapolate from the advanced/metastatic space that there would be a role for immunotherapy for patients with resected node + merkel cell. However, there is no clear data that support this approach. Majority of data looking at post operative systemic therapy + or - concurrent r...
What systemic treatment would you offer for metastatic HER2+ breast cancer that has progressed through THP and TDM-1 with predominant CNS progression and without localized treatment options?
For patients after 2 standard lines of HER2-targeted therapies with CNS progression who are not candidates for local CNS therapy, my first option would be to use trastuzumab plus tucatinib (with capecitabine if not previously used) if available (e.g. single patient IND). There is demonstrated activi...
Is the COVID-19 pandemic affecting your choice of high dose versus weekly cisplatin for definitive concurrent chemoradiation for HPV negative head and neck cancer?
No, it is not impacting my choice of high dose vs weekly cisplatin.
Should maintenance rituximab be held due to COVID-19 in patients with advanced bulky follicular lymphoma who attain a PR/CR to weekly rituximab?
Yes, hold rituximab. Independent of COVID-19, the RESORT trial demonstrated that retreatment on progression was equivalent to long-term maintenance with less exposure to the drug.
How do you distinguish between radiation necrosis, abscess, or disease recurrence in head and neck cancer patients?
This is a difficult clinical situation. I find physical exams including laryngoscopy to be of most use. If there are sharp borders and ulcers are soft with signs of infection, I will more likely suspect necrosis with super-infection. In this case, I will try antibiotics, antifungal, and antiseptic m...
Is there any contraindication to concurrent administration of radioactive iodine in a patient on immunotherapy?
Hello, unfortunately it is not known whether RAI can be given safely with nivolumab for treatment of PTC. Though I don't know of any absolute contraindications. Most of the studies using anti PD1 antibodies for metastatic thyroid carcinoma are in the RAI refractory populations. There are reports of ...