Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Is venetoclax expected to be useful in patients with refractory CLL/SLL who do not have Del(17p)?
Venetoclax is active in all types of CLL including those patients who do not have del(17p). In fact, the data thus far suggests that the durability of response will be better in this group of patients.
What would be your frontline therapeutic choice for a patient with Stage IV pancreatic adenocarcinoma with good PS but elevated bilirubin (4-5) due to tumor volume?
This is a difficult question. Treating advanced pancreatic cancer patients with significant organ dysfunction may not be appropriate when one considers the response rates of 20-30% in the first line setting and a poor overall prognosis. However, if a pateint has a good performance status, FOLFOX see...
For a young patient with stage 4 endometrial cancer with an excellent response to anthracyclines, would you continue to give anthracyclines beyond the standard dosage cap if cardiac function remains normal by echocardiogram?
A few things to consider in this case: What is the status of her stage IV disease/what response has she had to chemotherapy? How is she tolerating chemotherapy? If she has symptomatic disease and is contuning to respond to therapy, then it becomes a discussion of risk versus benefits (risk of cardio...
Based on the findings of the CALOR trial, among which group of patients with locoregional recurrence of hormone-receptor positive breast cancer would you treat with chemotherapy?
Look at the circumstances associated with local recurrence, review original pathology, did relapse occur while on endocrine therapy or off it, how late,..etc. All these are important questions. Generally, the vast majority of ER-positive local recurrences do not need nor are they responsive to chemo...
When (if ever) would you use fulvestrant up-front instead of an aromatase inhibitor for ER+ or PR+ metastatic breast cancer?
There are 2 scenarios based on the data and clinical guidelines that one can consider fulvestrant as 1st line therapy for ER+ metastatic breast cancer. Denovo or treatment naive stage 4 patients with bone only mets did better on fulvestrant vs an AI in the FALCON trial. SWOG 0226 showed a survival b...
Are there any indications on advanced stage Hodgkins disease that one might consider stopping the bleomycin after first two cycles?
The specific question was studied and the results published in NEJM June 2016 Barrington et al- Adapted treatment guided by PETCT in Advanced Hodkins LymphomaThe results suggested non-inferiority from the standpoint of PFS when bleomycin was omitted after an interim PET/CT suggested no disease. Pati...
In women in whom you suspect chemotherapy-induced amenorrhea and are required to start an AI, what is your strategy with regard to ovarian suppression?
For patients who were premenopausal at the time of breast cancer diagnosis (or shortly before) and who cease menses either spontaneously or due to chemotherapy, many will continue to have ovarian production of estrogen without periods, or resume periods for up to 2 years (and sometimes after even lo...
For elderly patients who cannot tolerate chemotherapy, is radiation alone an option for a stage IA favorable classical Hodgkin lymphoma?
In my experience, it has been extremely unusual that a patient with Hodgkin lymphoma is considered a non-candidate for chemotherapy. But I suspect that in community practice that situation may arise because very infirm patients are not referred to major centers and community oncologists may be a bit...
Do you consider local therapy in a patient with de novo metastatic triple negative breast cancer who has a complete response to first line chemotherapy?
I guess the question refers to a complete response in all detectable sites of metastasis and the primary. SHould that be the case, I would consider local therapy of the breast and the metastases if they were few (<3). Otherwise, I do not think the existing data are strong enough to do it.
In patients with good performance status, metastatic clear cell kidney cancer, and minimal metastatic disease, would you consider nephrectomy or partial nephrectomy if there are mets to brain?
Debulking nephrectomy has a clear role in the management of metastatic RCC, based on prospective trials showing an OS benefit. Patient selection, however, is critical for optimal benefit and minimizing risk. Brain metastases often portend a more aggressive systemic disease, and such patients often d...