Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Is there a role for maintenance lenalidomide after non anthracycline regimens in elderly patients with DLBCL?
Lenalidomide maintenance prolonged PFS among elderly patients with diffuse large B-cell lymphoma who had achieved partial or complete response to standard therapy (RCHOP), according to results of the phase 3 REMARC trial. It did not translate into OS advantage in the experimental arm. I would discus...
Would you use a NTRK TKI for a patient with metastatic HR+, HER2- breast cancer with a complex NTRK3 gene re-arrangement on Foundation testing?
While it's difficult to give an answer without knowing details of the fusion event, I would point to the potential for immunohistochemistry for Trk as an orthogonal method for identifying Trk expressing cancers with potential for testing Trk inhibitors. I would point to this paper for further inform...
Do you change systemic endocrine therapy for a patient who progresses only in the brain after SRS for metastatic HR+ breast cancer?
No, I would continue the same hormonal therapy until systemic progression. The brain is a sanctuary site. Disappointing that abemaciclib did not prevent since it crosses b-b barrier.
How do you manage TKI induced secondary polycythemia in a patient with RCC?
Fortunately this is fairly rare, although this has been described especially with axitinib. Polycythemia can also be RCC-related. I usually will engage my benign Heme colleagues who can help with the work up to ensure there are no other causes, and also direct phlebotomy as needed. I'm not aware thi...
What adjuvant therapy would you recommend to elderly patients with pT2N0 ER-/PR-/HER2+ breast cancer?
Yes, I agree you are a little outside the data zone here with a T2 tumor. However, for a patient over the age of 70 with comorbidities, I think paclitaxel/trastuzumab would be a very reasonable option and many of these patients elderly patients do not do well with TCH at standard dosing. I think aft...
Would you offer trastuzumab + pertuzumab alone for patients with early stage, HER2+ breast cancer for whom TCHP is clearly indicated but who adamantly refuse any cytotoxic therapy?
Yes, I would use this regimen pre-operatively, since our general process is to use TCHP (or THP) and de-escalate as needed for toxicity for patients with clinical stage T2 or N1 or higher. Here, the "de-escalation" is immediate due to strong patient preference (which of course should be documented)....
How would you incorporate ctDNA to follow up a patient status post surgical resection of the primary colon adenocarcinoma and omental deposits after 6 months of FOLFOX?
This is an excellent question. Can ctDNA add to the treatment algorithm for patients with peritoneal carcinomatosis where imaging frequently underestimates extent of disease? We are virtually in a data-free zone, but one study (Baumgartner, Ann Surg Oncol. 2018) showed that for 59 patients (mainly w...
What is your preferred second-line therapy for metastatic follicular dendritic cell sarcoma after progression on anthracycline-based chemotherapy?
Gemcitabine plus a taxane has good reported activity with an RR of 80% - Jain et al., PMID 28382648.
What adjuvant chemotherapy would you offer for completely resected carcinosarcoma of the pancreas?
This is such a rare neoplasm that obviously there is no standard of care. My only suggestion would be to look for an actionable mutation. Any treatment suggestion is just a guess.
Is it safe for a patient to breastfeed during their course of EBRT?
Not aware of any concerns. In our pregnancy-associated breast cancer patients, I encourage women to breastfeed on the side I am not treating as long as med onc has cleared them. We work with pediatricians to ensure that the infant is reaching normal weight/growth milestones, but may need to suppleme...