Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How do you utilize CDK 4/6 inhibitors in metastatic ER+ HER2+ breast cancer?
The benefit of adding a CDK4/6 inhibitor to the arsenal of treatment options in the hormone receptor (HR) and HER2-positive metastatic breast cancer setting is unknown. We are trying to answer this question through clinical trials, such as the multi-center Randomized, Open Label, Clinical Study of t...
What second line treatment would you choose for a post menopausal woman with HR+ HER2+ metastatic breast cancer with low burden disease treated with first line aromatase inhibitor and trastuzumab?
The TAnDEM trial did prove that triple-positive metastatic breast cancer should be treated with both anti-HER2 therapy and endocrine therapy. Although there is no direct data in the setting of the above-described case to my knowledge, we can extrapolate from the large body of evidence that exists fo...
For triple positive metastatic breast cancer, is there a role for aromatase inhibitor + CDK 4/6 inhibitor with Her2 directed therapy in a patient that refuses chemotherapy?
Recommend the PATINA trial, a randomized Phase 3 study. open to women or men with HR+, HER2+ metastatic breast cancer following completion of induction with anti-HER2-based chemotherapy. Would not recommend this approach outside of a clinical trial at this time, however.
Would you continue serial PSMA PET scans after 2 negative scans for patients with a persistently rising PSA post-RT?
Some context would probably be helpful for this. E.g., PSA >2 is different for a patient post-prostatectomy vs. post-radiotherapy. But, in general, if clinical suspicion of cancer recurrence/progression is high, and PSMA PET is negative, one can consider the following options: There may not be a ca...
Are there any scenarios you would use CDK 4/6i to treat HR-positive HER2-positive breast cancer in combination with anti-HER2 agents?
There is a strong preclinical data demonstrating that CDK4/6 inhibition reduces the growth of HER2-positive breast cancer cell lines. However, we are still awaiting the results of phase 3 trials testing the addition of CDK4/6 inhibitors to systemic therapy for hormone receptor (HR) positive, HER2 po...
How do you decide the right time to transition to hospice?
Talking about hospice is one of the hardest jobs we have. It's hard because we don't like doing it, because we often don't know how to do it well, and because we angst about doing it too early or too late. It's an important thing to think about. I actually think perhaps the most important factor in ...
Do you use elacestrant for all patients with metastatic ER+, HER2-, ESR1 mutated breast cancer regardless of duration of response to prior ET+CDK4/6i?
Use elacestrant on all patients with ESR1 mutation regardless of length of response
How do you manage maintenance for BRAF V600E-mutated metastatic colon cancer responding to FOLFOX + encorafenib + cetuximab (BREAKWATER) in the first line?
I would treat with mFOLFOX plus encorafenib and cetuximab for 8-12 cycles, provided responding/tolerating, and then maintain on encorafenib and cetuximab without the 5-FU till progression/intolerance.
Do you consider bleeding risk in elderly, frail patients with atrial fibrillation to be similar for all NOACs?
I believe that apixaban carries a lower risk of bleeding, with particular reference to GI bleed, when compared to rivaroxaban and dabigatran. This is true in the population of AF patients at large and most probably in frail patients as well.
What is the preferred sequence of systemic therapy in a patient with endocrine resistant HR+ metastatic breast cancer?
Several factors can affect the next line of therapy in my view like disease free interval (DFI) before the patient developed metastatic disease, duration of response (if any) to prior endocrine with/without CDK4/6i, disease burden, patient's performance status and competing comorbidity. If the patie...