Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How would you approach the management of a patient with oligometastatic NSCLC characterized by a LUL mass and a solitary adrenal metastasis, assuming a good performance status?
Induction chemotherapy (platinum-doublet x3 cycles) followed by lobectomy, mediastinal lymph node dissection, and adrenalectomy if no progression after induction chemotherapy.Reference: Gomez DR et al, Lancet Oncology 2016
What is the role of platinum agents in the treatment of metastatic breast cancer in patients with BRCA mutations?
The TNT study compared taxanes versus carboplatin in triple negative breast cancer and did not show a difference in response rate. However, amongst BRCA germline mutation carriers there was a significantly higher response rate amongst women with BRCA mutations. Therefore, platinums are good options ...
For patients with RCC who respond to PD-1 blockade, do you ever discuss stopping treatment?
It has only been a year since nivolumab was approved for the treatment of metastatic renal cell carcinoma (mRCC). In the absence of long term follow up data, especially in the real world setting, it is difficult to conclude whether stopping treatment with nivolumab in responding patients is appropri...
For the rare NSCLC patient who achieves a CR on anti-PD-1 or PD-L1 therapy, do you consider either spacing out dosing intervals or offering treatment breaks?
Taking a break is always worth discussing in situations like this. Often the patient and doctor are a bit reluctant (understandably), but in the absence of data from the pivotal trials to date it seems reasonable for some.
How do you interpret the results of the ACT II trial in terms of the choice between cisplatin and mitomycin in the treatment of anal cancers?
As you know, the ACT II conclusion was that a 5-FU/cisplatin regimen did not improve outcomes and had similar toxicities (less hematologic toxicities) when compared to the standard of care 5-FU/MMC. The RTOG 9811 trial demonstrated worse DFS/OS with induction followed by concurrent 5-FU/cisplatin. B...
Do you prefer fulvestrant over an AI in advanced hormone receptor + breast cancer?
As expected, FALCON was positive for PFS benefit. OS report is awaited. These results give us another option to treat HR+ MBC in first-line setting, along with palbociclib + AI and an AI-alone option. In my personal practice, I use AI-alone in patients with low volume bone-only disease in first line...
How do you approach further management in patients with initially unresectable hepatocellular carcinoma who are downstaged after transarterial chemoembolization?
There is a nice study recently published by a Chinese group looking at this very question (Zhang et al, Is Salvage Liver Resection Necessary for Initially Unresectable Hepatocellular Carcinoma Patients Downstaged by Transarterial Chemoembolization? Ten Years of Experience. Oncologist. 2016 Dec;21(12...
When determining treatment approach to newly-diagnosed follicular lymphoma (e.g. watchful waiting vs chemotherapy), do you take the intensity of the SUV measurements on PET into account?
The short answer is NO. The SUV value does not inform the decision between a "watch and wait" vs. chemotherapy approach. Overreliance on SUV values in newly diagnosed follicular lymphoma is not recommended. The intensity of SUV measurement may, however, aid in locating a site for biopsy. For example...
How do you approach prostate cancer patients with persistent obstructive lower urinary tract symptoms after primary radiation therapy?
If the persistent LUTS is due to radiation treatment, and medical therapy is not sufficient -- then I would refer the patient to urology for consideration of a channel TURP. Patients with metastatic cancer can have local (prostate) disease progression and experience significant obstructive symptoms ...
Is CA 27-29 helpful in surveillance of patients with Stage I-III breast cancer in remission?
There is not really any data supporting the use of surveillance tumor markers in breast cancer and is discouraged in ASCO guidelines. In known metastatic patients, I will check both CA 15-3 and CA 27-29.