Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
What is your adjuvant treatment approach to patients with strongly hormone-receptor positive breast cancer who have minimal response to neoadjuvant chemotherapy?
Many patients with strongly hormone receptor-positive tumors, including lobular cancers, may not respond to chemotherapy either clinically or by pathological response. In these patients, lack of response may not correlate with a worse long-term outcome to the same extent that it would in triple nega...
How do you talk to patients about clinical trials?
I try to incorporate the clinical trial idea into the standard of care recommendation/discussion at the time of initial treatment decision making. After making a standard of care rx recommendation, I tell patients that my recommendation is based upon this treatment being the winner of a prior trial ...
Is there any form of liquid biopsy that can detect ER and Her 2 expression for metastatic breast cancer?
Yes. The Circulating Tumor Cell Assay is able to detect ER and HER2 expression. But it has not been validated in prospective studies. I do not recommend using it for this purpose as we just do not know the sensitivity and specificity of such an assay. We have previously written a commentary about on...
Do you use oral etoposide in combination with carboplatin for small cell lung cancer, in light of the national shortage of IV etoposide?
Our preferred treatment for extensive SCLC is a platinum compound + IV etoposide. However with the national shortage, and our preference to "save" IV etoposide for metastatic germ cell tumors, we would use a platinum compound + irinotecan which is equivalent albeit with more G.I. toxicity. Another e...
What factors other than resection status (R1,2) do you consider when offering adjuvant chemotherapy for patients with thymic carcinoma, and how do you coordinate with post-op radiation?
I do not routinely recommend adjuvant chemotherapy for patients with resected thymic carcinoma as there is no data that this improves outcome. If not an R0 resection, then we recommend post-operative radiation therapy.
What chemotherapeutic regimen would you use to treat locally recurrent TNBC?
Triple Negative Breast Cancers are sensitive to DNA-damaging agents so I would be inclined to use carbo/taxol or cisplatin/gemcitabine regimen. There are several points that I consider important to make" 1. If there an accessible metastatic site to biopsy, then biopsy it. It gives confirmation to th...
What is the role of upfront pembrolizumab in metastatic PD-L1 positive NSCLC presenting with SVC syndrome?
This is a "trick question" as there are at least 3 difficult questions hidden here- Can systemic therapy replace the need for local therapy in urgent clinical situations traditionally calling for radiation? What is the best upfront treatment regimen for a patient with PD-L1 positive NSCLC? What is t...
What growth factor would you use with A+AVD, if any at all?
When treating patients with Hodgkin lymphoma with either ABVD or A-AVD I decide if their risk of febrile neutropenia is likely to be more than 20%, which, therefore, includes some patients on ABVD and most patients on A-AVD. For such patients I give GCSF (filgrastim, grastophil) on days 6-11 after e...
Do you ever consider the use of weekly (as opposed to bi-weekly bortezomib) for newly diagnosed multiple myeloma patients who are transplant eligible?
Is it necessary to hold immunotherapy during a 4-6wk steroid taper after resolution of immunotherapy related toxicity?
This is an excellent question. Most of the clinical trials with checkpoint inhibitors required complete taper of steroids prior to rechallenging wtih immunotherapy following toxicity. As we use immunotherapy in the clinic, and have utilized combinations with chemotherapy, including regimens that use...