Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How many cycles of docetaxel do you give to patients with metastatic castration resistant prostate cancer?
Toxicity with Neuropathy can be a major problem in the elderly population.
Would you consider HRT in a young woman (<35 years old) with gBRCA mutated TNBC who underwent bilateral mastectomies and BSO?
I would use HRT for the beneficial effects of bone preservation, lipid improvement, sexual function, and quality of life. My preference is for women to have a concurrent hysterectomy with the BSO so the HRT can be estrogen alone, which has little, if any, risk for promoting breast cancer. In the les...
In patients who have pneumonitis related to ALK inhibitor therapy, is it possible to rechallenge patients with the same drug or a different ALK inhibitor?
Lung toxicity in patients treated with ALK TKIs is a rare event, occurring in about 1-2% of patients, but can be serious and life threatening. Ceritinib may be associated with slightly less pulmonary adverse events (around 1%), while crizotinib, alectinib and lorlatinib are associated with pulmonary...
With recent measles outbreaks occurring in the US, would you consider offering multiple myeloma patients s/p ASCT on maintenance treatment vaccination, or an alternate means of immunity?
Measles is on the rise and protection is appealing. The current guidelines for adult immunizations are not clear what patients with monoclonal gammopathy (MGUS), smoldering myeloma (SMM), or multiple myeloma should do. Are they all immunocompromised? Are they all immunocompromised to the same amount...
After progression on osimertinib, do you recommend overlapping TKI with 2nd line chemotherapy to avoid accelerated disease progression?
I do not continue the EGFR TKI in patients once clear evidence of clinical and radiologic progression makes me recommend a switch from an EGFR TKI to chemotherapy. This approach is considered due to reports regarding the potential tumor flare phenomena noted upon discontinuation of EGFR TKIs. There ...
How would you manage an elderly patient with a history of stage I CLL and newly diagnosed metastatic ER+/HER2+ breast cancer?
The focus would be on the diagnosis which seems most likely to be life-limiting and/or a source of morbidity. Although there aren't many details here regarding the metastatic ER+ HER2+ breast cancer (e.g. where are the mets? Bone? Liver? Are there symptoms?) one presumes that this is more life-limit...
How do you approach adjuvant chemotherapy in early stage ER+ breast cancer who developed pneumonitis on ddAC?
Neulasta with ddAC can cause an interstitial pneumonia or reaction like pneumonitis. If she was node positive, younger and you think rechallenging her is reasonable (the pneumonitis was grade 1-2 and resolved quickly on steroids) then you could try to do the remaining AC q3wk without Neulasta to see...
How would you treat a triple negative large (~ 6 cm) cancer in a woman in her second trimester of pregnancy?
There is data for the safety of anthracyclines in pregnant women. I would treat her with AC every three weeks for up to 4 cycles with close monitoring by a high risk obstetrician. There is also data for the safety of paclitaxel. I would treat her with chemotherapy till delivery and then proceed with...
In the absence of specific driver mutations, are you routinely offering combination chemotherapy + immunotherapy first-line for metastatic squamous cell carcinoma of the lung in patients with autoimmune disease, but not currently on immunosuppression?
It depends on the nature of their autoimmune disease. If a patient has antiphospholipid antibody syndrome, it may be quite dangerous. If isolated antibody without clinical syndrome, IO may or may not unmask APLS. That said, metastatic squamous lung cancer is incurable and the only chance for durable...
Do you consider MET amplification in your first-line treatment decisions for patients with metastatic NSCLC?
Not at present and nothing is FDA approved or NCCN guidelines. Second line or later yes, especially on a trial