Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
What factors might influence your initial treatment decision of oligometastatic NSCLC assuming good performance status, lack of actionable mutation, and PD-L1 status < 50%?
When do you use immunotherapy with MSI high advanced colorectal cancer?
Based on the available data from the KEYNOTE trials and CheckMate 142, I use immunotherapy in the second-line (or greater) setting. There is no data at this time to support front-line use, so I would only consider that for patients who are not good candidates for combination chemotherapy. KEYNOTE-17...
Do you have a preferred strategy for front line induction therapy in DLBCL patients who have asymptomatic depressed ejection fraction and thus concern about anthracycline dosing?
I generally replace the anthracycline in RCHOP with etoposide 50 mg/m2 IVPB Days 1-3 based on an ASH abstract #408 in 2009 by Sehn L et al. If the day 2 and 3 doses of etoposide are given orally rather than IV the dose would be 100 mg/ m2.
For patients with advanced gastric/GEJ cancer expressing PDL1, is there data to support frontline pembrolizumab?
I agree with Dr. @Dr. First Last's comments regarding the Keynote 059, 061, and 062 studies. However, there are new data presented at the 2020 ESMO meeting. The Keynote 590 is a phase III study enrolled 749 patients with advanced esophageal and GEJ cancer (including esophageal squamous cell carcino...
In what scenario would you prefer to use every two weeks paclitaxel over weekly paclitaxel in the adjuvant treatment of breast cancer?
I prefer weekly taxol and don't use DD taxol often. Sometimes it is patient preferred because of the shorter duration altogether, or if there is a long travel distance then coming less frequently may make sense.
Do you ever consider local therapy to oligometastatic hormone-receptor positive breast cancer?
Surgery or radiation therapy in metastatic breast cancer patient is one of hot topics in care of the patients with stage IV disease, especially since the survival of oligometastatic breast cancer and widely spread metastatic breast cancer is vastly different. For instance, the 5 year survival of oli...
What is the your choice of treatment after progression or AE following pembrolizumab in metastatic melanoma?
There is unfortunately limited prospective randomized data to guide us after progression due to anti-PD-1 therapy in metastatic melanoma. There is little benefit to re-challenging with the other anti-PD1 therapy (pembro or nivo after nivo or pembro etc) and dependent on AE would most likely not re-c...
How would you manage papillary variant squamous cell carcinoma of the oropharynx?
We prefer to approach papillary variant squamous cell carcinoma with a surgical approach. These cancers can be related to HPV (either high risk or mucosal subtypes) and generally carry a good prognosis. A selected neck dissection should be considered and if the tumor is larger or more invasive than ...
What is your preferred approach to the treatment of transplant ineligible multiple myeloma that has been treated with a triplet regimen and reached a plateau phase?
The depth of response translate into better PFS and OS. Partial response is not appropriate today. We have better combinations that can lead to that. We need to get our patients into CR as soon as possible. After we are there we can talk about maintenance.
Would you use trastuzumab with chemotherapy in a patient with metastatic gastric cancer that is HER2 negative but ERBB3 positive?
No, there are clearly no validated data for this and I do not have any anecdotal experience to suggest benefit. Such a patient should be referred for studies of pan-ErBB inhibitors, e.g. afatinib or neratinib.