Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Would you use 6 months (instead of 12 months) of trastuzumab for locally advanced Her-2 positive breast cancer patients?
I would not recommend 6 months of maintenance trastuzumab for higher risk patients, such as one that received neoadjuvant therapy. The PERSEPHONE trial1 had as its strength its large size and sufficient number of events for a conclusion regarding the population tested (and the diversity of regimens ...
In light of the recently published CARMENA trial, is there still a role for cytoreductive nephrectomy in metastatic RCC patients?
Several features of CARMENA make the data not applicable to all mRCC patients with primary in place. These include a large percentage of poor risk/poor PS patients, lack of receiving intended protocol therapy, including delayed nephrectomy in almost 1 of every 5 patients, and a primary tumor burden ...
Does Keynote 189 establish combination chemoimmunotherapy as the standard of care for Stage IV lung adenocarcinoma?
If the Insigna trial is available, to me that is the best way of addressing this. Otherwise I would not. To me KN189/407 represents the current standard of care in the US relative to KN42 which appears inferior. For those that make argument about patient with poor performance status etc for KN42, th...
What is your current preferred approach in the management of metasatic sarcomatoid NSCLC?
This is certainly a very relevant question not just as to the proper management of pulmonary sarcomatoid carcinoma but also other rare cancer subtypes in general where it is hard to know how to properly utilize information obtained on more common subtypes of the same malignancy. Many times we have t...
For patients with distal esophageal adenocarcinoma who are not surgical candidates, how do you decide between the preferred chemotherapy regimens when given as definitive chemo-radiation?
My regimen of choice has fluctuated over the years. At MSKCC, our institutional standard was previously cisplatin/irinotecan (Ilson, Cancer 2012). This was abandoned after the results of the CROSS study were presented in 2010, establishing a global benchmark for tolerability and a highly respectable...
In which patients with stage IV NSCLC and PD-L1 TPS >50% plus concomitant autoimmune disease is it considered safe to give immune checkpoint blockers?
Given the adverse events of special interest noted with immune checkpoint blockers - specifically immune related AEs (or irAEs), the safety (and efficacy) of using these drugs in patients with pre-existing autoimmune disorders is not entirely clear. To date, most (if not all) studies have excluded p...
Do you incorporate carboplatin into the treatment for triple negative breast cancer?
In the neoadjuvant setting, I recommend the addition of carboplatin in all patients (unless medically contraindicated) with stage IIA or higher TNBC. There are now 3 randomized studies - CALGB 40603, GeparSixto and BrighTNess - that have demonstrated significantly higher pCR rates with carboplatin t...
How do you treat non-resectable carcinoid of the thymus?
As with all neuroendocrine tumors, there is tremendous heterogeneity in disease biology and response to treatment. There are, indeed, some quite slow-growing thymic carcinoid tumors which could be suitable for observation, especially in asymptomatic patients (interestingly, while males affected by M...
Would you offer imatinib to a patient with a high risk GIST (> 10 cm, low Ki-67, s/p complete resection) who initially declined adjuvant therapy, but is now interested 14 months post surgery?
In general adjuvant treatment is usually initiated within 3 months of diagnosis. It would be helpful to know more detail about this GIST. For example, where was it located, what was the mitotic count and was any mutational analysis performed. I am not aware of any data which specifically addresses ...
How would you approach a biopsy proven NSCLC patient with mediastinum negative disease and contralateral suspicious spiculated PET avid nodule without pathologic diagnosis?
This is a scenario I have faced before. Sometimes unfortunately in spite of staging studies, the stage a lung cancer patient has might remain a bit unclear. In this situation if this is a functioning patient with good PFTs who is a surgical candidate I would consider treating him like he has 2 separ...