Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Would you offer systemic therapy after rendered NED from SRS to isolated CNS metastases in a patient with prior curative intent treatment of lung adenocarcinoma and clear cell RCC?
What is the best approach for patients with DLBCL with early relapse (< 6 months) after initially attaining a CR with 6 cycles RCHOP?
Early relapse, regardless of interim imaging, suggests chemorefractory disease. It may be that we selected a more chemo/rituxan resistant clone that comprised a smaller % initially that has now become dominant. Regardless of pathophysiology, I think for today we are stuck with the same paradigm: sal...
How are you counseling HR-proficient ovarian cancer patients about front line PARP inhibitor maintenance?
I think this is a tough decision, but I recommend observation for patients with HR proficient disease. In brief, I don't find a PFS advantage, without a proven OS advantage, enough to justify this long-term, expensive, and not non-toxic treatment.For BRCA carriers the answer is easier—with SOLO2 (20...
Does ER+ status impact your choice of neoadjuvant systemic therapy in premenopausal women with cT2N0 HER2+ breast cancer?
In general for T2N0 HER2+ breast cancer, I would recommend neoadjuvant TCH or AC-TH, or one of those regimens + pertuzumab, with the decision about inclusion vs omission of pertuzumab based on the limited absolute benefit in APHINITY for node negative breast cancer; but understanding that with a neo...
When during ALL induction therapy are you checking for MRD?
It is generally advisable to measure MRD from a bone marrow aspirate at the end of the first course of therapy for ALL. If a pediatric-inspired regimen such as CALGB 10403 is being used, undetectable MRD after Remission Induction (i.e., approximately Day 28) is associated with an excellent rate of d...
What treatment would you offer a young pregnant woman with a symptomatic midline low grade glioma?
The question is really in the biology of this midline low grade glioma, in particular K27M status and BRAF status, amongst others. It is very challenging to answer without a clear idea of the tumor and ongoing symptoms. It would also be important to have a look at the MRI scan. Eric Bouffet eric.bou...
How would you treat a mixed neuroendocrine/adenocarcinoma appendiceal tumor with metastasis to the liver?
I find it helpful to ask pathology to comment on the individual tumor components. If there is a substantial adenocarcinoma component in the tumor, I worry that platinum/etoposide may be inadequate as therapy. For a predominantly high-grade, poorly differentiated neuroendocrine carcinoma with a minor...
Would you hold rituximab for newly diagnosed B-cell lymphoma if the patient is COVID-19 positive?
The question of how best to manage ongoing lymphoma therapy in the face of SARS-CoV-2 infection remains unanswered. That said, centers are developing guidance for clinicians based upon available and emerging data. Newer data from MSKCC suggest that recent treatment (within the last 30 days) is not a...
What is your approach to unresectable metastatic rhabdomyosarcoma transformed from an embryonal cell germ cell tumor?
More information would be helpful. I infer this is a patient who underwent an orchiectomy for a more typical histology of germ cell cancer, probably with elements of teratoma. He may or may not have had elevated hCG or AFP. He may or may not have received BEP or similar chemotherapy. Perhaps he had ...
How would you approach adjuvant therapy for resected spindle cell rhabdosarcoma of the tongue?
From a practical management and chemo-sensitivity standpoint, I would think of this as a UPS and not the conventional embryonal/alveolar RMS. I would favor completing the SOC local control with XRT and re-stage a month later. If still with NED and the patient wants to be aggressive, reasonable to co...