Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How do you minimize the risk of cardiotoxicity in metastatic Her2 + breast cancer patients who are receiving trastuzumab and have a history of pre-existing cardiac disease?
Currently there are no proven strategies that are widely used to minimize the risk of cardiac toxicity in patients receiving Her2 therapy. Development of inexpensive, protective regimens with minimal side effects for patients at risk for cardiac dysfunction and the devlopment of models identifying w...
Do you have a preferred regimen for patients with HER-2 positive metastatic breast cancer who have progressed through THP followed by T-DM1?
3rd line and beyond for Her-2 disease is a bit of an open playing field, especially compared to our scripted THP and T-DM1 in the 1st and 2nd lines respectively. Many use capecitabine + lapatinib, or another chemotherapy backbone and revisit trastuzumab (such as navelbine/trastuzumab, or gem/trastuz...
How do you balance aspiration risks with encouraging PO intake for HN cancer patients during and after chemoradiation?
The main challenge is to identify the patients who are most prone to aspirate during and after Tx. Chemo-RT-related aspiration is frequently “silent”: the patient does not recognize he/she aspirates, and neither does the observer. The risk of aspiration is assessed by modified barium swallow perform...
What is the rate of a cardiac events that you quote to a patient with preexisting heart disease going on trastuzumab for metastatic Her2+ breast cancer?
I tell patients that it depends on their baseline risk factors and that some have reported rates as high as 25-28%. I discuss that if they have had prior anthracycline therapy, borderline baseline LVEF (50-54%), age > 65, and other cardiac risk factors like hypertension, that they could fall into th...
How would you approach the adjuvant management of locally advanced pancreatic neuroendocrine tumor s/p resection with positive margins and positive lymph nodes (high lymph node ratio, + LVI, low grade and well differentiated)?
We know that the factors of positive margins, positive lymph nodes and LVI all confer a heightened risk of relapse. It is critical to ensure good post-operative staging and I would suggest a multiphase CT, Gallium 68 Dotatate scan and Chromogrannin A. If there is no evidence of residual disease, we ...
Would you use apalutamide in high risk non-metastatic castrate resistant prostate cancer?
I would consider using apalutamide for the appropriate patient, which I would define as meeting the entry criteria for the study i.e. PSA DT 10 months or less. The label for the drug is broad i.e. any castration resistant PSA only patient, which I beleive is too far to inclusive, many of these folks...
What is your experience with liposomal-encapsulated daunorubicin and cytarabine (CPX-351) for first line treatment of therapy-related AML or AML with myelodysplasia-related changes in elderly patients?
Our center has been administering CPX-351 to outpatients for the last few months. We monitor the patient closely in the first week for tumor lysis. Since the neutropenic fever rate is the same as 7&3 we have need to admit many of the patients at some point in the cycle but overall it has gone very w...
Would you consider primary tumor resection in a patient with oligometastatic colon cancer with complete metabolic response after 6 months of initial chemotherapy?
Do you give 3 or 4 cycles of HiDAC during consolidation for good/intermediate-risk AML without an available allotransplant donor?
This is a complicated question because risk stratification of AML has rapidly transitioned from including clinical presenting features (age, WBC, co-morbid diseases) with cytogenetics/select mutations to now multiple mutations and other biologic features. An example is core binding factor AML with a...
How do you approach a lung malignancy with a single pleural nodule near a primary?
This is a relatively rare scenario. For example, in a Korean series of almost 4,000 patients undergoing surgery for NSCLC, 78 (2%) were found to have unexpected pleural seeding intra-operatively (Thorac Cardiovasc Surg 2018;66:142). A small number of surgical reports suggest, that when limited seedi...