Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Do you rely on Ki67 as an estimate of proliferation to guide the decision for chemotherapy in premenopausal women with hormonally-driven breast tumors?
Far from it. Especially in premenopausal women, Ki-67 is affected by circulating hormones and time of the month, and it is not a reliable indicator of endocrine resistance. In postmenopausal women, the most valuable Ki-67 reading is on endocrine therapy if any, not baseline either. Ki-67 should not ...
Do you recommend adjuvant or indefinite systemic therapy after surgery/radiation for patients with synchronous bilateral breast cancers that are of the same histology and receptor status?
Synchronous bilateral breast cancer is rare and often presents with concordant histology, but is generally considered 2 primaries rather than metastatic disease due, possibly, to common exposures of similar clones. Despite controversy and conflicting reports, long term survival has been reported. It...
How do you manage rituximab-induced neutropenia?
Rituximab induced neutropenia is a relatively rare but well known phenomenon and can occur in the immediate post treatment period as well as a late sequela of rituximab treatment. In my experience, patients often improve with administration of G-CSF. In cases where a patient's ANC remains <500, I co...
Would you use a platinum containing regimen in the adjuvant setting for a triple negative breast cancer patient with contraindications to anthracycline based therapy?
The question specifically pertains to a patient with contra-indication to anthracyclines. However, I will try to provide my opinion on various situations. 1. I generally do not use carboplatin in adjuvant management of triple negative patients who have contra-indication to anthracyclines. I just us...
If a patient with myeloma develops a symptomatic DVT or PE while on an immunomodulatory drug such as lenalidomide, would you stop the IMiD?
In general I prefer using enoxaparin (most convenient LMWH in US) or apixaban (least renally dependent Xa inhibitor) in myeloma patients for IMiD-induced VTEs. I don't generally wait 7-10 days as the anticoagulant effect is rapid for these agents. While compliance is always challenging with injecti...
Were there any practice changing studies for pancreatic cancer presented at the ASCO 2017 annual meeting?
The ASCO 2017 meeting included presentations of research regarding a number of pertinent GI topics, perhaps most notably the plenary session involving the IDEA pooled meta-analysis regarding 6 v 3 months of adjuvant chemotherapy for resected stage III colon cancer. Having said that, there was relati...
Is venetoclax expected to be useful in patients with refractory CLL/SLL who do not have Del(17p)?
Venetoclax is active in all types of CLL including those patients who do not have del(17p). In fact, the data thus far suggests that the durability of response will be better in this group of patients.
What would be your frontline therapeutic choice for a patient with Stage IV pancreatic adenocarcinoma with good PS but elevated bilirubin (4-5) due to tumor volume?
This is a difficult question. Treating advanced pancreatic cancer patients with significant organ dysfunction may not be appropriate when one considers the response rates of 20-30% in the first line setting and a poor overall prognosis. However, if a pateint has a good performance status, FOLFOX see...
For a young patient with stage 4 endometrial cancer with an excellent response to anthracyclines, would you continue to give anthracyclines beyond the standard dosage cap if cardiac function remains normal by echocardiogram?
A few things to consider in this case: What is the status of her stage IV disease/what response has she had to chemotherapy? How is she tolerating chemotherapy? If she has symptomatic disease and is contuning to respond to therapy, then it becomes a discussion of risk versus benefits (risk of cardio...
Based on the findings of the CALOR trial, among which group of patients with locoregional recurrence of hormone-receptor positive breast cancer would you treat with chemotherapy?
Look at the circumstances associated with local recurrence, review original pathology, did relapse occur while on endocrine therapy or off it, how late,..etc. All these are important questions. Generally, the vast majority of ER-positive local recurrences do not need nor are they responsive to chemo...