Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
What factors other than resection status (R1,2) do you consider when offering adjuvant chemotherapy for patients with thymic carcinoma, and how do you coordinate with post-op radiation?
I do not routinely recommend adjuvant chemotherapy for patients with resected thymic carcinoma as there is no data that this improves outcome. If not an R0 resection, then we recommend post-operative radiation therapy.
What chemotherapeutic regimen would you use to treat locally recurrent TNBC?
Triple Negative Breast Cancers are sensitive to DNA-damaging agents so I would be inclined to use carbo/taxol or cisplatin/gemcitabine regimen. There are several points that I consider important to make" 1. If there an accessible metastatic site to biopsy, then biopsy it. It gives confirmation to th...
What is the role of upfront pembrolizumab in metastatic PD-L1 positive NSCLC presenting with SVC syndrome?
This is a "trick question" as there are at least 3 difficult questions hidden here- Can systemic therapy replace the need for local therapy in urgent clinical situations traditionally calling for radiation? What is the best upfront treatment regimen for a patient with PD-L1 positive NSCLC? What is t...
What growth factor would you use with A+AVD, if any at all?
When treating patients with Hodgkin lymphoma with either ABVD or A-AVD I decide if their risk of febrile neutropenia is likely to be more than 20%, which, therefore, includes some patients on ABVD and most patients on A-AVD. For such patients I give GCSF (filgrastim, grastophil) on days 6-11 after e...
Do you ever consider the use of weekly (as opposed to bi-weekly bortezomib) for newly diagnosed multiple myeloma patients who are transplant eligible?
Is it necessary to hold immunotherapy during a 4-6wk steroid taper after resolution of immunotherapy related toxicity?
This is an excellent question. Most of the clinical trials with checkpoint inhibitors required complete taper of steroids prior to rechallenging wtih immunotherapy following toxicity. As we use immunotherapy in the clinic, and have utilized combinations with chemotherapy, including regimens that use...
Would you offer further systemic therapy to a patient with triple-negative breast cancer treated with neoadjuvant chemotherapy, BCT, and adjuvant capecitabine who has a local failure while receiving capecitabine?
A very tough situation. There are times when I’ve yearned to have a patient-derived xenograft model running so I can test and evaluate for chemo sensitivity. There are no such tests like that now, and the in vitro chemo sensitivity assays have not been validated. To add to this point, if we perform ...
How do you decide which lab to use for multi-gene hereditary testing?
Many commercial companies offer multi-gene panel testing for cancer susceptibility genes. The decision about whether to choose small, medium, and large multi-gene panels depends upon the patient's personal and family history of cancer and also personal preferences. Larger panels have higher rates of...
How do you approach the subsequent management of a patient with appendiceal adenocarcinoma (T4bN2M1a) with completely resected single peritoneal and omental deposits?
This is a largely data-free zone when it comes to prospective trials but many excellent retrospective studies exist on the topic. There are data (NCDB, institutional and others) to suggest a benefit of adjuvant therapy (see Asare EA et al. Cancer 2016;122:213-21). I would look carefully at the grade...
What is your approach to genetic testing for high risk patients?
At our center, clinical assessment initiated at diagnosis and anybody who meets the NCCN criteria is referred to genetic counsellor