Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Would you offer further systemic therapy to a patient with triple-negative breast cancer treated with neoadjuvant chemotherapy, BCT, and adjuvant capecitabine who has a local failure while receiving capecitabine?
A very tough situation. There are times when I’ve yearned to have a patient-derived xenograft model running so I can test and evaluate for chemo sensitivity. There are no such tests like that now, and the in vitro chemo sensitivity assays have not been validated. To add to this point, if we perform ...
How do you decide which lab to use for multi-gene hereditary testing?
Many commercial companies offer multi-gene panel testing for cancer susceptibility genes. The decision about whether to choose small, medium, and large multi-gene panels depends upon the patient's personal and family history of cancer and also personal preferences. Larger panels have higher rates of...
How do you approach the subsequent management of a patient with appendiceal adenocarcinoma (T4bN2M1a) with completely resected single peritoneal and omental deposits?
This is a largely data-free zone when it comes to prospective trials but many excellent retrospective studies exist on the topic. There are data (NCDB, institutional and others) to suggest a benefit of adjuvant therapy (see Asare EA et al. Cancer 2016;122:213-21). I would look carefully at the grade...
What is your approach to genetic testing for high risk patients?
At our center, clinical assessment initiated at diagnosis and anybody who meets the NCCN criteria is referred to genetic counsellor
How do you treat a young woman of child bearing age group diagnosed with primary CNS lymphoma?
The first step is to check HIV serology to ensure that the patient is HIV negative as HIV+ve patients would need to antiretroviral therapy promptly along with chemotherapy or the prognosis is dismal. If patient is young and fit the initial approach is similar in both HIV +ve and -ve patients. Assumi...
Would you give adjuvant chemotherapy to a post-menopausal woman with strongly ER/PR positive locally advanced lobular carcinoma with >3 axillary LNs?
The total body of evidence for the 21-gene assay in the setting of 1-3 LNs is supportive of the current NCCN guidelines, which suggest considering that patients with ER+ disease, one to three positive nodes, and low RS can avoid adjuvant chemotherapy and receive endocrine therapy alone, on the ba...
Do somatostatin based therapies have any role in treating neuroendocrine tumors that are silent on octreotide scanning ?
Possibly...there seems to be an association between the intensity of uptake and response to somatostatin analogs (SSAs) in patients with G2/G3 NETs. Almost all express somatostatin receptors (SSTRs) to some degree. The big question is how you assess for the presence of receptors. Octreoscans have lo...
How would you approach a Follicular grade 1-2 NHL found on a terminal ileum biopsy with otherwise negative EGD and colonoscopy and contrast enhanced CT scan?
At our facility, we have treated a significant number of patients with low grade lymphoma isolated to a single fixed site within the GI tract with excellent long term results. It is worth considering a dose of 2400 rads to the involved site.
What is your threshold for transfusing platelets in an asymptomatic patient after autologous stem cell transplant?
My thresold for transfusing platelets in an asymptomatic patient after autologous stem cell transplant is the same as with other patients - transfuse for plts<10 unless febrile or if any bleeding complications, at which time the threshold would be higher.
Is there a role for PD-1 inhibitors for metastatic or locally recurrent cutaneous squamous cell carcinomas after failure of first line therapy, EGFR inhibitors?
Yes. response rate close to 50%. Look at ASCO abstract from 2017 phase 1 looking at new PD-1 inhibitor in treat this disease