Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
What strategies have you found to be most effective in engaging PCPs in a primary-care or shared-care model of survivorship for pediatric and AYA patients who will receive ongoing care in their communities away from their primary oncology treatment site?
This is a challenge for our center, and many other centers as well. The ideal approach would be to have adult primary care physicians associated with our center who have dedicated clinic time to care for cancer survivors, direct access to our expertise and medical records. While we haven't been succ...
Will you offer adjuvant olaparib to patients with somatic BRCA mutated breast cancer given that OlympiA only enrolled germline BRCA+?
I agree that the 3-year DFS benefit is quite compelling for considering adjuvant olaparib in patients meeting the eligibility criteria in NSABP B55 (Tutt et al., PMID 34081848). This also raises the possibility of clinical benefit in other scenarios, particularly those where PARPi have shown meaning...
How would you sequence 177LU-PSMA-617 with current therapies for men with mCRPC?
I would like to congratulate the VISION study investigators and Dr. @Dr. First Last for the outstanding presentation and good news. The study was designed to use a hybrid control (best "standard of care"-SOC) and as such, it met its endpoints (OS, rPFS, etc). Secondary endpoints also significantly f...
What neoadjuvant chemotherapy would you consider for squamous cell carcinoma arising from a ruptured tailgut cyst?
Tailgut cysts are congenital lesions that develop from tailgut embryonic remnants. Though malignant transformation has been described, literature is largely limited to case reports. I would ensure the patient has been adequately staged with PET/CT and/or MRI of the pelvis. If resectable, I would adv...
Are there any clinical scenarios in which you would treat BRCA mutated HER2 negative metastatic breast cancer with a PARP inhibitor in combination with carboplatin?
There is a large prospective phase III study that showed a significant improvement in DFS for veliparib+carbo+ paclitaxel versus carbo+paclitaxel (BROCADE3 study; Dieras V et., PMID 32861273).
How would you manage anastomotic site recurrence of colon cancer 3 years after resection of a T3N0 tumor without high-risk features?
I will do metastatic work up. If negative:- FOLFOX.
How often do you follow ferritin and organ iron-deposition in a patient who has known hereditary hemochromatosis, but no current evidence of iron overload?
Once diagnosis is made, I stress blood donation or less optimally, therapeutic phlebotomy. If donation every 56 days until ferritin <100 and TSAT <30. This assumes asymptomatic without LFT abnormality. Thereafter the intervals can be adjusted to keep parameters in the desired range. I never follow o...
How long do you continue caplacizumab in relapsed refractory TTP?
While there are no data from studies to guide our answer, general practice is to continue caplacizumab until the ADAMTS13 activity is at least 20% on two occasions, or greater than 30% assuming it was measured at least 4-5 days after the last plasma exchange procedure. The goal is to have stable rec...
Would you consider the use of ctDNA as part of surveillance in high risk TNBC patients?
Patients with significant residual TNBC following NAC have an increased risk of recurrence and death within 3 years, despite SOC adjuvant capecitabine (EA1131). The presence of ctDNA following initial active treatment (using Signatera or other platforms) has reliably shown to predict risk of recurre...
Would you offer a RET inhibitor for a RET-mutated medullary thyroid carcinoma after R1 resection in a patient with elevated calcitonin?
RET inhibitors have not yet been studied in the adjuvant setting in MTC (or in other RET-driven cancers for that matter). Thus, it is not considered SOC to start a RET specific inhibitor in the adjuvant setting following surgery for MTC, even when calcitonin and/or CEA are elevated. In the post-oper...