Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
For patients with RCC who respond to PD-1 blockade, do you ever discuss stopping treatment?
It has only been a year since nivolumab was approved for the treatment of metastatic renal cell carcinoma (mRCC). In the absence of long term follow up data, especially in the real world setting, it is difficult to conclude whether stopping treatment with nivolumab in responding patients is appropri...
For the rare NSCLC patient who achieves a CR on anti-PD-1 or PD-L1 therapy, do you consider either spacing out dosing intervals or offering treatment breaks?
Taking a break is always worth discussing in situations like this. Often the patient and doctor are a bit reluctant (understandably), but in the absence of data from the pivotal trials to date it seems reasonable for some.
How do you interpret the results of the ACT II trial in terms of the choice between cisplatin and mitomycin in the treatment of anal cancers?
As you know, the ACT II conclusion was that a 5-FU/cisplatin regimen did not improve outcomes and had similar toxicities (less hematologic toxicities) when compared to the standard of care 5-FU/MMC. The RTOG 9811 trial demonstrated worse DFS/OS with induction followed by concurrent 5-FU/cisplatin. B...
Do you prefer fulvestrant over an AI in advanced hormone receptor + breast cancer?
As expected, FALCON was positive for PFS benefit. OS report is awaited. These results give us another option to treat HR+ MBC in first-line setting, along with palbociclib + AI and an AI-alone option. In my personal practice, I use AI-alone in patients with low volume bone-only disease in first line...
How do you approach further management in patients with initially unresectable hepatocellular carcinoma who are downstaged after transarterial chemoembolization?
There is a nice study recently published by a Chinese group looking at this very question (Zhang et al, Is Salvage Liver Resection Necessary for Initially Unresectable Hepatocellular Carcinoma Patients Downstaged by Transarterial Chemoembolization? Ten Years of Experience. Oncologist. 2016 Dec;21(12...
When determining treatment approach to newly-diagnosed follicular lymphoma (e.g. watchful waiting vs chemotherapy), do you take the intensity of the SUV measurements on PET into account?
The short answer is NO. The SUV value does not inform the decision between a "watch and wait" vs. chemotherapy approach. Overreliance on SUV values in newly diagnosed follicular lymphoma is not recommended. The intensity of SUV measurement may, however, aid in locating a site for biopsy. For example...
How do you approach prostate cancer patients with persistent obstructive lower urinary tract symptoms after primary radiation therapy?
If the persistent LUTS is due to radiation treatment, and medical therapy is not sufficient -- then I would refer the patient to urology for consideration of a channel TURP. Patients with metastatic cancer can have local (prostate) disease progression and experience significant obstructive symptoms ...
Is CA 27-29 helpful in surveillance of patients with Stage I-III breast cancer in remission?
There is not really any data supporting the use of surveillance tumor markers in breast cancer and is discouraged in ASCO guidelines. In known metastatic patients, I will check both CA 15-3 and CA 27-29.
How do you treat a patient with synchronous locally advanced lung and head and neck cancers?
This is obviously a very difficult and challenging clinical situation. Most people have a very difficult time undergoing simultaneous treatment to both areas. Typically, I have started with induction systemic therapy. This is especially useful for larynx and hypopharynx cancer patients. This provide...
When do you use neoadjuvant endocrine therapy for postmenopausal women with ER positive early stage breast cancer?
I think that neo-adjuvant endocrine therapy is an excellent option particularly for post-menopausal women with strongly ER/PR + cancers who are marginal candidates for breast conservation. I will generally consider for those women who don't have any characteristics that I think would require chemoth...