Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How and when are you using sipuleucel-T in metastatic prostate cancer given the increase in available treatment options?
At the present time, they do not. The options of treatment in the mHSPC setting include ADT, NHT, and docetaxel only. There are some ongoing clinical trials evaluating the combination of immune therapy with PD-1/PD-L1 checkpoint inhibitors and docetaxel or NHTs currently. Some phase II clinical tria...
Can you use other iron formulations if a patient develops Stevens-Johnson Syndrome with ferumoxytol?
I have never seen it in tens of thousands of doses so it is difficult to answer. If this is actually real, it must be due to CHO component and not Fe (that would be awful). I would use another formulation and premedicate with steroid and H2 blocker before. Do not use antihistamine.
What is the role of preoperative radiation in patients with bone metastases needing surgical stabilization (ie. ORIF), but without tumor resection?
It depends on the patient’s primary diagnosis, extent of disease (multiple metastases vs oligometastastes), and life expectancy. These factors help us formulate a treatment plan on whether we are going to deliver higher ablative doses for patients with longer life expectancy where the ultimate aim i...
What is the preferred adjuvant therapy for high-risk non-clear cell RCC?
Unfortunately, non-clear cell RCC (nccRCC) has not been included in past or current adjuvant trials. Sunitinib, which has limited effect in the adjuvant setting, would be expected to have even less in nccRCC given relative activity in the metastatic setting. A similar scenario exists for IO adjuvant...
How would you approach therapy for a patient with high-grade sarcoma who is unable to tolerate systemic cytotoxic chemotherapy, but whose tumor revealed NRAS G12A, BRCA1, and MET amplification?
I would try weekly cisplatin. Cisplatin is the best drug there is vs tumors with BRCA1 polymorphisms. You need reasonable kidney function for cisplatin but bad liver does not mean bad kidneys. Platinum is safe, with less hematologic toxicity than other chemos. You don't need a port. Weekly cisplatin...
Would you consider adding HER2 targeted treatment to chemotherapy for a patient with locally advanced, HER2+ rectal cancer who is going to have total neoadjuvant treatment?
There are approximately 3-5% metastatic colorectal cancer patients who have HER2 amplification detected by either IHC, FISH, or by NGS that includes an RNA test (Loree et al., PMID 29718453).Clinical trials showed convincing evidence that HER2 targeted treatment is effective for HER2 positive metast...
How do you approach the management of a patient with extensive small cell lung cancer who has progressed on third-line therapy, with borderline functional status, complicated by paraneoplastic CNS syndrome?
Given the overall poor prognosis of small cell lung cancer, I would be inclined to start with a goal of care discussion. Many clinical trials still require ECOG PS 0-1 and I do not believe in "fudging" PS for borderline patients to enroll on a trial. I may consider single agent chemotherapy - lurbin...
How would you approach immunosuppression for patients with severe aplastic anemia who are not transplant or ATG candidates?
There are relatively few alternatives. One is just supportive care with transfusion, antibiotics, etc. Many patients will adapt to low Hb and do ok with low platelets and do not require therapy. A calcineurin inhibitor alone or with eltrombopag can also be used - the response rate is not as good as ...
With advancing and new therapies emerging for metastatic HER2+ breast cancer, how does one decide between options for third line therapy at time of progression?
Barring any contraindications, tucatinib would be my preferred third line after progression on traz/pertuz and ado-traz.
Which chemotherapy regimen would you recommend for locally recurrent TNBC several years after therapy with docetaxel + cyclophosphamide for four cycles?
Typical regimens for TN breast cancer include TC, AC-T, AC-TCb +/- Pembro, and CMF. The CALOR data supports using adjuvant chemotherapy for recurrence. Details that I would usually consider when selecting a regimen in this setting include: Does the patient have residual side effects or co-morbiditie...