Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How do you factor time from past cytotoxic chemotherapy exposure into diagnosing therapy-related AML?
The WHO criteria do not specify a defined time criteria for the diagnosis of therapy-related AML. WHO writes, "Most cases of t-AML present within 10 years of the most recent exposure, and the origin of AML in cases with very long latent periods may be unrelated to therapy." But even if a patient pre...
What upfront maintenance therapy would you recommend for a BRCA negative, advanced epithelial ovarian cancer patient after completing adjuvant carboplatin, paclitaxel, bevacizumab?
Without knowing the somatic genetics, I’d recommend niraparib. If she was BRCA+ or HRD+ by somatic testing, I’d consider Olaparib plus bevacizumab.
Would you offer concurrent chemoradiotherapy and/or adjuvant systemic therapy (chemo or immunotherapy) or for a completely resected stage III Merkel cell after WLE and ALND?
One would potentially extrapolate from the advanced/metastatic space that there would be a role for immunotherapy for patients with resected node + merkel cell. However, there is no clear data that support this approach. Majority of data looking at post operative systemic therapy + or - concurrent r...
What systemic treatment would you offer for metastatic HER2+ breast cancer that has progressed through THP and TDM-1 with predominant CNS progression and without localized treatment options?
For patients after 2 standard lines of HER2-targeted therapies with CNS progression who are not candidates for local CNS therapy, my first option would be to use trastuzumab plus tucatinib (with capecitabine if not previously used) if available (e.g. single patient IND). There is demonstrated activi...
Is the COVID-19 pandemic affecting your choice of high dose versus weekly cisplatin for definitive concurrent chemoradiation for HPV negative head and neck cancer?
No, it is not impacting my choice of high dose vs weekly cisplatin.
Should maintenance rituximab be held due to COVID-19 in patients with advanced bulky follicular lymphoma who attain a PR/CR to weekly rituximab?
Yes, hold rituximab. Independent of COVID-19, the RESORT trial demonstrated that retreatment on progression was equivalent to long-term maintenance with less exposure to the drug.
How do you distinguish between radiation necrosis, abscess, or disease recurrence in head and neck cancer patients?
This is a difficult clinical situation. I find physical exams including laryngoscopy to be of most use. If there are sharp borders and ulcers are soft with signs of infection, I will more likely suspect necrosis with super-infection. In this case, I will try antibiotics, antifungal, and antiseptic m...
Is there any contraindication to concurrent administration of radioactive iodine in a patient on immunotherapy?
Hello, unfortunately it is not known whether RAI can be given safely with nivolumab for treatment of PTC. Though I don't know of any absolute contraindications. Most of the studies using anti PD1 antibodies for metastatic thyroid carcinoma are in the RAI refractory populations. There are reports of ...
Do you continue somatostatin analogs beyond progression to maintain disease control in low-intermediate grade neuroendocrine tumors?
Unfortunately there is no clear data on whether to continue somatostatin analogues (SSA) upon progression in NETs. Certainly for a functional tumor (ie carcinoid syndrome) it makes perfect sense to continue an SSA.An exception to continuing SSA upon progression is considered when we examine the NETT...
Outside of a clinical trial, what is your preferred first-line therapy for a fit patient with de novo metastatic spindle cell sarcoma?
Hard to answer definitively without knowing the location of primary and better clinical and/or pathology clarification. Assuming a better definition of path is not possible, I would favor Doxorubicin (75 mg/m2) plus Ifosfamide (10 g/m2 divided into 4 or 5 daily doses). Additional information may wel...