Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How do you decide to choose TC vs CMF for HER2 negative breast cancer patients who warrant adjuvant chemotherapy?
There are various modifications of CMF. Most of the data on the efficacy of CMF is based on the "classic" dose and scheduling, i.e. IV MTX and 5-FU on day 1 and 8, and oral cyclophosphamide on day 1-14 of a 28-day cycle. [Historically, this regimen was developed to duplicate the schedule of the high...
Is there any role for additional chemotherapy for a pre-menopausal woman with locally advanced ER+, Her2- IDC, with residual disease after neoadjuvant AC?
That there would be residual disease after Neoadjuvant chemotherapy is not a surprise due to the biology and the main strategy for long time cure and control is the endocrine therapy that follows.
Do you routinely check echocardiograms for patients getting HER2 directed therapy for metastatic breast cancer?
I monitor LVEF with echocardiography at 3 months' intervals. My rationale is that changes in LVEF can then be addressed in real time in an attempt to prevent further cardiac decompensation, symptomatic cardiac events, and discontinuation of Her2 targeted therapy. We’re currently looking at prophylac...
Have you used immunotherapy for NSCLC in a patient with multiple sclerosis?
This is a challenging question. Traditionally patients with immune mediated or autoimmune illnesses were excluded from PD1 or PDL1 inhibitor clinical trials. There is some retrospective data emerging in NSCLC and in melanoma that some patients with autoimmune conditions could be safely treated with ...
Which systemic therapy would you use to treat a poorly-differentiated round cell sarcoma with CIC-DUX4 gene fusion?
A patient with a sarcoma such as this should be evaluated at a multidisciplinary sarcoma center, including pathology review. I would favor treating with a Ewing sarcoma regimen as these can be very aggressive tumors. A small series recently reported at the annual CTOS meeting of CIC rearranged small...
Would you consider offering adjuvant chemotherapy to a patient with HR+, Her2- T1c disease with negative axillary lymph nodes, but with a positive intramammary node?
Yes, I would consider adjuvant chemotherapy for this node-positive breast cancer. Yes, the emerging evidence is suggestive that Oncotype DX is as useful in node-positive as in node-negative breast cancer for determination of prognosis and probably decisions regarding indications for chemotherapy. Ga...
Would you continue consolidation temozolomide for more than 1 year for a patient with grade 3 anaplastic astrocytoma, after gross total resection and daily temozolomide+EBRT?
Thank you for the question.The short answer is, "no". There is no data that adjuvant chemotherapy beyond 12 months improves outcomes. The temozolomide is usually very well tolerated, but it is associated with bone marrow injury with myelodysplasia or leukemia as risks. So, in general with no upside,...
Do you use Oncotype to determine the benefit of adjuvant chemotherapy in a male patient with breast cancer?
While there are fewer data, and no randomized data, what exists suggests that male breast cancer is comprised of a similar range of biologic entities, although the distributions may differ a little from female breast cancer. The question is timely; a recent JCO article (Massarweh et al, JCO 2018), e...
Would you use enzalutamide concurrently in combination with radium-223?
In ERA223, men with asymptomatic to minimally symptomatic, chemotherapy-naive, metastatic castration-resistant prostate were randomized to receive either radium-223 OR placebo (6 cycles), administered concurrently with abiraterone acetate/prednisone. In December 2017, the independent data/safety mon...
How would you approach management of a large retroperitoneal mass that shows seminoma on biopsy?
Cure rate should be 90-95% with BEP X 3 ( EP X 4 if over age 50) . No need to consider a mixed tumor. Postchemo, he with be in P.R. and would then just observe residual mass with serial CT scans.