Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Would you consider exemestane (instead of fulvestrant) in post-menopausal patients with hormone receptor pos, HER2- breast cancer who progress on letrozole or anastrozole?
Generally would not. I usually do Fulvestrant +/- CDK inhibitor if not received in the first line setting, as second line and reserve exemestane to afterwards combined with everolimus. If a patient has minimal disease progression on letrozole/anastrozole and really does not want a monthly injection,...
What systemic therapies would you consider for a patient with HER2 positive breast cancer with progressive brain metastases despite whole brain radiation, but no systemic disease?
This is one of the most challenging scenarios that we face in breast oncology . Radiation therapy remains the mainstay of treatment. For patients with progressive brain mets after whole brain radiation, there may be a role for gammaknife.Regarding systemic therapy, there is a paucity of data regardi...
What systemic therapy would you offer a colon cancer patient after resection of oligometastatic disease that developed while on adjuvant therapy?
Do you ever utilize an anthracycline based regimen rather than a non-anthracycline based regimen for patients with locally advanced HER2 positive breast cancer?
I do not use a lot of AC-THP except in a few cases where we had multicentric or multifocal locally advanced breast cancer that had both HER2+ and HER2- disease concurrently so we had to "cover our bases" for both disease types so to speak. For straightforward HER2+ disease, the 3-year EFS data from ...
Would you continue her 2 neu directed therapy for a patient with breast cancer if a biopsy on progression confirms Her 2 neu negative disease?
There is no good evidence-based answer to this question even though biomarkers (ER, PR, HER2) can change over time (eg. from primary to metastatic recurrence, or pre and post neoadjuvant therapy) in 5-30% of cases.1 There are no large series assessing outcomes based on changing or not changing thera...
Would you consider localized therapies such as radiofrequency ablation to a lung metastasis or Yttrium-90 for liver metastases for disease control for ER+HER2- breast cancer patients with visceral oligometastatic disease who have progressed on all hormonally-targeted therapies and have chemotherapy as their next standard-of-care systemic treatment option?
If truly oligometastatic, then yes I would consider it. Would do a PET-CT plus bone scan to make sure no other site of disease beforehand. Would consider duration of disease free survival before making a decision. If patient has been disease free for a long time, I would consider treatment of oligom...
How do you sequence therapy for metastatic NSCLC patient with a BRAF V600E mutation?
In a newly diagnosed patient with metastatic NSCLC that harbors a BRAF V600E mutation, my preferred first line therapy is the combination of Dabrafenib plus Trametinib. My recommendation is based upon the high response rate (65%) of this combination observed in phase II trials. I would inform the pa...
Would you send a gene assay like Mammoprint or Oncotype on a small (<1 cm) lymph node negative lobular infiltrating carcinoma?
I would not, especially if it was low grade and proliferative rate. "Clinical low" patients by MINDACT categorization had excellent prognoses without chemo, although admittedly, this is not specific to patient with lobular histology... Moreover, it is challenging to have enough tissue for a genomic ...
Would you use lapatinib to prevent recurrence of brain mets in a patient with recurrent brain-only mets from HER2+ breast cancer now rendered NED after radiation?
Options for treating a patient like this are quite numerous and could include lapatinib among other possibilities. Lapatinib, especially when combined with capecitabine, showed good response rates in the CNS. Lapatinib has better CNS penetration than other anti-HER2 agents. However, it is important ...
What is your treatment approach to patients with extremity sarcoma with multiple positive regional nodes?
We generally include lymph nodes > 3 cm or multiple lymph nodes in the first echelon area if within a reasonable distance to the primary in the preoperative volume. For first echelon nodes at greater distances from the primary site without in transit involvement, we would separate out the primary CT...