Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
For male patients in chronic phase CML on a TKI and not yet in a MMR, is there a preferred amount of time spent in a MMR before discontinuing TKI therapy to conceive or bank sperm ?
Hard to answer this one. My preference would be that the patient be in MMR confirmed by two readings three months apart before experiencing a dose interruption.
Would you ever omit adjuvant therapy for rectal cancer in patients who underwent primary resection (TME), without any neoadjuvant therapy?
What is your approach to the upfront treatment of anaplastic large cell lymphoma, ALK positive, with low IPI score in a young person?
ALK positive ALCL is the most responsive of the aggressive PTCL’s to chemotherapy, and the majority of young patients can be cured with an anthracycline containing chemotherapy regimen. Either CHOP or CHOEP (ie CHOP plus etoposide) are frequently used. In a young healthy patient I favor CHOEP based ...
Would you use ado-trastuzumab as first line therapy for metastatic Her2+ breast cancer in a post-menopausal woman who developed metastatic disease years after finishing dual Her2 directed therapy?
The FDA label provides for upfront useage of TDM1 if the patient develops metastatic recurrence within 6 months of adjuvant therapy. In this case since it has been years i would try dual blockade with TPH again as the patient may respond again.
Do you rely on Ki67 as an estimate of proliferation to guide the decision for chemotherapy in premenopausal women with hormonally-driven breast tumors?
Far from it. Especially in premenopausal women, Ki-67 is affected by circulating hormones and time of the month, and it is not a reliable indicator of endocrine resistance. In postmenopausal women, the most valuable Ki-67 reading is on endocrine therapy if any, not baseline either. Ki-67 should not ...
Do you recommend adjuvant or indefinite systemic therapy after surgery/radiation for patients with synchronous bilateral breast cancers that are of the same histology and receptor status?
Synchronous bilateral breast cancer is rare and often presents with concordant histology, but is generally considered 2 primaries rather than metastatic disease due, possibly, to common exposures of similar clones. Despite controversy and conflicting reports, long term survival has been reported. It...
How do you manage rituximab-induced neutropenia?
Rituximab induced neutropenia is a relatively rare but well known phenomenon and can occur in the immediate post treatment period as well as a late sequela of rituximab treatment. In my experience, patients often improve with administration of G-CSF. In cases where a patient's ANC remains <500, I co...
Would you use a platinum containing regimen in the adjuvant setting for a triple negative breast cancer patient with contraindications to anthracycline based therapy?
The question specifically pertains to a patient with contra-indication to anthracyclines. However, I will try to provide my opinion on various situations. 1. I generally do not use carboplatin in adjuvant management of triple negative patients who have contra-indication to anthracyclines. I just us...
If a patient with myeloma develops a symptomatic DVT or PE while on an immunomodulatory drug such as lenalidomide, would you stop the IMiD?
In general I prefer using enoxaparin (most convenient LMWH in US) or apixaban (least renally dependent Xa inhibitor) in myeloma patients for IMiD-induced VTEs. I don't generally wait 7-10 days as the anticoagulant effect is rapid for these agents. While compliance is always challenging with injecti...
Were there any practice changing studies for pancreatic cancer presented at the ASCO 2017 annual meeting?
The ASCO 2017 meeting included presentations of research regarding a number of pertinent GI topics, perhaps most notably the plenary session involving the IDEA pooled meta-analysis regarding 6 v 3 months of adjuvant chemotherapy for resected stage III colon cancer. Having said that, there was relati...