Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Can we ever observe newly diagnosed chronic phase CML patients and not immediately start them on therapy?
I can't think of a situation that would justify a "watch and wait" approach to CML. There are a number of effective therapies. Even if a patient has side effects from one TKI, there are others to choose from. What justification is there for not using an effective therapy? What is the rationale? Da...
Has the combination of daratumumab, bortezomib, and dexamethasone been tried for the treatment of plasma cell leukemia?
Do you ever discontinue ibrutinib in patients with CLL who have a good response?
For patients who are responding well to ibrutinib and tolerating the drug well, I do not discontinue ibrutinib. The clinical trials of single agent BTK inhibitors have all continued therapy indefinitely, which is a logical approach considering that very few will attain minimal residual disease negat...
How would you treat a T1b N0 metaplastic myoepithelial breast cancer regarding role of adjuvant therapy?
Assume triple neg. Depends on patient's age and performance status and lots of discussions. I would definitely not treat a T1a and would have to have strong reasons to treat a T1b
Do you offer bladder-sparing approaches as an alternative to cystectomy for surgery-eligible patients with muscle-invasive bladder cancer?
We have a bladder cancer multispecialty clinic at SCCA/UWMC in which we also see patients with localized MIBC and we balance carefully risks vs benefits, rationale, data, details & logistics of options. Overall, cisplatin-based chemotherapy (for fit patients) ->radical cystectomy with PLND, OR maxim...
Which chemotherapy regimen (if any) do you recommend for palliative concurrent chemoradiation for a symptomatic patient with metastatic cervical carcinoma and CKD stage 4 (GFR 15-29)?
For patients who cant get cisplatin because of poor kidney function, we have used taxol at 45-50 mg/m2 weekly ( metabolized through liver) based on phase 2 data. In our experience it is tolerated well.
How many cycles of post-operative adjuvant chemotherapy do you typically plan for a patient with resected mesothelioma?
There are no radnomized data to guide us on this issue. Our standard post-operative approach consists of 4 cycles of pemetrexed and cisplatin, using the NSCLC adjuvant chemotherapy paradigm. The addition of systemic therapy to surgical resection (typically extended pleurectomy at our institution) is...
What is your approach to adjuvant therapy for patients with ER negative, PR positive early stage breast cancer?
ER-negative but PR-positive is unusual (<5%) but not unheard of, and is worth repeating receptors to make sure is accurate. Assuming confirmed, given uncertainty about the nature of these tumors, I treat them as I do ER borderline (1-9%) tumors, with endocrine therapy but some skepticism about likel...
How do you sequence systemic therapy in locally advanced metaplastic breast cancer with squamous features?
We have generaly seen even lower response rates to neoadjuvant chemo in metaplastic with predominantly squamous features than in other metaplastic tumors, so that gives me pause about neoadjuvant chemo, and I would favor direct to surgery if operable. I am not aware of this being described specifica...
Will you start using ribociclib instead of palbocicib in advanced HR-positive HER2-negative breast cancer?
Information available to date shows that both the therapeutic and safety profiles of palbociclib and ribociclib are identical, so there is no evidence-based method to select one over the other. I feel perfectly comfortable in working with both agents and will continue to do so. There are many remain...