Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
When do you refer a patient with metastatic ovarian cancer for upfront debulking v. neoadjuvant chemotherapy?
In general, I would advise referring the patient to a gynecologic oncologist prior to chemotherapy as the decision regarding upfront versus interval debulking is complicated and best made assessing the patient and her imaging in person. However, if it is not possible to get the patient referred in a...
Do you perform biomarker-based screening for AL amyloidosis in patients with newly diagnosed MGUS?
No, unless the patient has signs and symptoms or imaging studies that suggest systemic Amyloidosis.
Can paclitaxel and trastuzumab be given neoadjuvantly in Her2 positive breast cancer?
While there is some rationale for this with the idea that if pCR is achieved with a minimalist approach then maybe one can omit additional chemotherapy the truth is that we have not yet demonstrated that this de-escalating method is valid and will achieve the same outcomes that are meaningful, e.g. ...
Would you consider the use of intrathecal chemotherapy in patients with diffuse spinal metastasis due to squamous cell lung cancer?
My bias is that the response rate for IT chemotherapy for a non-oncogene driven cancer is low enough, that I typically do not consider this. Palliative radiation is reasonable, and in addition, while the question refers specifically to squamous cell lung cancer, this might be the situation in which ...
Should GnRH agonist therapy be continued beyond 5 years (along with an aromatase inhibitor) in young pre-menopausal women with high risk breast cancer who continue to have ovarian function at 5 years of endocrine treatment?
My response of 'No' assumes that the patient has been on OFS (with either tamoxifen or an AI) for her first 5 years of adjuvant endocrine therapy. We have no data on benefit of OFS beyond 5 years, the benefit on continuing AI beyond 5 years is very modest, especially in regards distant recurrence, w...
Do you recommend bevacizumab in platinum sensitive recurrences of epithelial ovarian cancer?
Bevacizumab was approved for use in combination with chemotherapy followed by continued bevacizumab maintenance in patients with platinum-sensitive recurrent ovarian cancer in December 2016. This approval was based on the findings of 2 studies, GOG-213 and the OCEANS trial. Both trials demonstrated ...
What is your alternative first line approach to follicular lymphoma that requires treatment if initial treatment with BR leads to significant neutropenia despite G-CSF?
My approach depends on the number of cycles the patient has received and the response to those cycles, along with reason for neutropenia (all treatment based vs disease related). If a patient has significant neutropenia from treatment/therapy, my initial approach would be to add GCSF for the next cy...
How are you treating patients who progress while on durvalumab after definitive chemoradiation for stage III NSCLC?
I usually recommend a bx to confirm the presence of metastatic disease. I ensure that all other biomarker information is available, including PD-L1 is obtained, of not performed already. In the absence of actionable/ targetable mutations, I offer patients a KN189/KN407 type regimen at the time of pr...
How do you discuss avoiding pregnancy in the premenopausal patient while on chemotherapy and/or endocrine therapy?
We have an active discussion in any PRE-menopausal patient, which is documented in the chart along with their method of contraception. A pregnancy test is obtained prior to the start of chemotherapy, but not routinely repeated unless there is reason (e.g. patient reports not using an contraception, ...
What is your approach to metastatic non-clear cell RCC?
A majority of the clinical trials conducted in renal cell carcinoma are conducted exclusively in clear cell carcinoma. We know from retrospective analyses (De Velasco et al Clin GU Cancer 2017) that these patients have a worse prognosis with traditional therapy. Small randomized trials dedicated exc...