Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Would you do ALND for low ER pos (1-10%), Her2 + patient with positive sentinel lymph nodes?
The question whether an axillary lymph node dissection is therapeutic or diagnostic has not been completely addressed. Data is supportive that a complete lymph node dissection is not necessary in a ER+lower risk group of women undergoing a lumpectomy with radiation For HER2 positive patients and w...
Do you have a preference for a CDK4/6 inhibitor for first line metastatic HR positive breast cancer in combination with faslodex?
I do not have a preference for a CDK 4/6 inhibitor when given with fulvestran for metastatic ER+/Her-2 - breast cancer. Both palbociclib and abemaciclib are approved in combination with fulvestrant. There are differences in terms of dosing, schedule, and side effects. But, these features don't sugge...
Do you have any concerns about enhanced radiation toxicity with any of the novel agents used to treat multiple myeloma?
I agree with Dr Vesole.
How do you decide on the sequence of systemic and local therapy for patients with oligometastatic NSCLC?
Since patients are already metastatic, systemic progression is the deadliest threat to these patients, so systemic therapy is most important. It will help select out patients with favorable biology that may benefit from aggressive local treatment. The trial that showed a PFS benefit sequenced system...
Is further workup and management required for an incidentally found small focus of neuroendocrine tumor of the endometrium?
It depends on the grade and differentiation. Primary endometrial tumors are very rare and tend to be high grade and poorly differentiated. A lower grade tumor, especially an implant on the peritoneal surface, is much more likely to be a metastasis, most likely from a GI primary. A sample obtained at...
For patients with muscle-invasive bladder cancer and borderline renal function, would you consider use of a split-dose cisplatin/gemcitabine regimen for neoadjuvant treatment?
Yes, in patients with borderline creatinine clearance, e.g. 50-59cc/min, we tend to split cisplatin dose, e.g. 35 mg/m2 on days 1 and 8, if gemcitabine/cisplatin is used, or on days 1 and 2, if dd-MVAC is used. Also, we consider 24-hour urine testing to assess more accurately creatinine clearance in...
How would you approach the therapy in a patient with metastatic colon cancer (hepatic and limited non-hepatic metastases) that completely responded with systemic therapy in the non-hepatic sites but has limited hepatic disease?
Is there a substitution for etoposide you would recommend for testicular cancer patients who need multiple cycles of BEP?
If it is good risk disease can use our old regimen of cisplatin + vinblastine + bleomycin (PVB) as it was equivalent to BEP therapeutically in the good risk patient population. For intermediate or advanced disease, VeIP or TIP.
How do you approach CNS prophylaxis in double-hit lymphoma patients?
There is no consensus about the need for IT chemo for CNS prophylaxis in DLBCL. Factors such as IPI, the number and location of extranodal sites of disease, and LDH may be used to identify a group of patients with aggressive NHL who are at particularly high risk for CNS recurrence and might therefor...
Do you give radiation concurrently with adjuvant pertuzumab in locally advanced Her2 pos breast cancer?
The most directly relevant data are APHINITY, in which adjuvant RT was given concurrently with HER2-targeting; good cardiac outcomes were seen in that study.