Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
What strategies do you employ to mitigate mucositis related pain during the treatment of head and neck cancer?
The bottom line is there is no magic bullet that works well. I start Glutamine a week before and throughout the duration of the treatment. It seems to delay the onset. I use custom made mouth pieces to reduce dental scatter if possible--that will reduce mucositis I start with over the counter analg...
What is your approach to patients with locally advanced triple negative breast cancer with residual disease at the time of surgery?
These patients remain at very high risk for metastatic recurrence and therefore should receive adjuvant chemotherapy with capecitabine as standard of care, radiation therapy, and considered for participation in the following adjuvant clinical trials: (1) SWOG S1418 (pembrolizumab versus observation)...
How do you approach non-metastatic castration-resistant prostate cancer?
The two recent placebo controlled trials comparing apalutamide and enzalutamide in M0CRPC (SPARTAN and PROSPER) have shown sizeable and consistent effects on various outcome measures, clearly met the primary study endpoints and hence satisfied FDA regulatory criteria for drug approval in this space....
Is there a preferred neoadjuvant chemotherapy regimen for a marginally-resectable, dedifferentiated, MDM2+ liposarcoma?
In our experience, neoadjuvant chemotherapy alone is unlikely to convert someone from marginally resectable to more resectable. These patients are better served with neoadjuvant radiation therapy with the addition of weekly doxorubicin/cisplatin being an additional consideration.
How do you approach isolated recurrence in a para-aortic lymph node following definitive radiation for localized prostate cancer?
This is a challenging situation with no data to guide therapy; it is not unreasonable to pursue novel PET imaging (PSMA on trial, fluciclovine) to ensure there is no evidence of other sites of metastatic disease. The treatment of oligometastatic disease continues to evolve. In this situation, I woul...
Now that there are three FDA-approved PARP inhibitors for use in ovarian cancer (niraparib, rucaparib, olaparib), how do you decide which one to use?
One, niraparib is only approved for maintenance after treatment of platinum sensitive recurrence. Olaparib and rucaparib are approved for treating active, measurable disease. Olaparib for germline BRCA mutation carriers after 3 prior therapies, rucaparib for treating patients with germline or somati...
What is your approach to the use of denosumab in patients with metastatic breast cancer with bony involvement?
I do not extrapolate the results of OPTIMIZE-2 and CALGB 70604 to denosumab. It is a different drug and until appropriate studies are performed, there is no reason to change its dose or schedule.
How would you treat a Stage II gastric adenocarcinoma with de-differentiation to high grade neuroendocrine tumor post resection?
This is a challenging scenario... what to do with a mixed-phenotypic tumor such as this, which is actually not all that uncommon and we all face from time to time? For a pure gastric adenocarcinoma s/p resection (stage II/III), I favor a Capox/FOLFOX-type regimen, a la the Korean phase III CLASSIC t...
Would you consider a trial of anti-PD-1 therapy following disease progression through anti-PD-L1 therapy for advanced urothelial carcinoma?
This is a great question and should be answered in a clinical trial setting. We need trials in patients with progression on anti-PDL1 or anti-PD1 agent; currently we don't have data to answer this question of cross-resistance
What is the optimal regimen for advanced stage Nodular Lymphocyte Predominant Hodgkin Lymphoma?
I do not believe that there is an "optimal" chemotherapy regimen for advanced nodular lymphocytic predominant Hodgkin lypmhoma. The most commonly used regimen is probably ABVD +/- rituximab. CHOP-R might be a good choice when the question of early transformation to diffuse large B-cell lymphoma is s...