Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Do you treat atypical carcinoid of the lung with N2 or N3 nodal involvement with definitive concurrent chemoradiation?
I agree that these are very difficult cases due to the lack of data for either radiation or chemotherapy responsiveness in bronchopulmonary NETs. When possible we try to offer surgery. For patients with resectable N2 disease, I would recommend surgery and then consider adjuvant chemotherapy for atyp...
Would you use cetuximab or panitumumab to treat a patient with stage IV colon cancer who is KRAS/NRAS wild-type but has a PIK3CA mutation in tumor tissue?
Would you give additional chemotherapy to women with stage III HER2+ breast cancer who have a grossly suboptimal response to neoadjuvant TCHP x6?
It really would depend on the hormone receptor status of the patient. If a patient was ER positive, one may not expect a pCR from TCHP, and they may benefit from Neratinib extended therapy based on the ExteNET trial. The HR was 0.6 for IDFS for the patients that had tumors that were hormone receptor...
What chemotherapy regimen would you recommend for high risk ER+/Her2- LN negative breast cancer with high genomic risk disease?
For the patient described, with high genomic risk but otherwise good-risk features (ER positive, HER2 negative, node negative) I would recommend TC x 4 cycles as reported in Jones et al (JCO 2009, 27:1177). The use of anthracycline plus taxane adds benefit overall as shown in the ABC trials, but for...
Would you consider age of 70 years as a contraindication (without any other cardiac risks) to use anthracycline in a triple negative breast cancer patient?
As always, it depends. The DFS advantage for anthracycline-based regimens over TCx6 in the ABC trials (J Clin Oncol 35:2647, 2017) was for patients with lymph node involvement, so they were at high risk. In a fit woman who is age 70 or older, the benefits of including the anthracycline likely outwei...
Why do we give four cycles of TC as adjuvant therapy when some of the clinical trials administered six cycles?
There are three trials I use to think about this issue: USOR 9735 (TC x 4 vs AC x 4, Jones et al JCO 2009; 27: 1177-1183), ECOG 1199 (AC x 4 with paclitaxel qw x 12, vs taxol q3w x 4, vs docetaxel qw x 12, vs docetaxel q3w x 4, Sparano et al JCO 2015; 33: 2353-2360) and the ABC analysis (TC x 6 vs T...
How would you approach a patient who progressed on immunotherapy for merkel cell carcinoma?
This is an excellent question in a rare disease where we have clearly seen the use of immunotherapy leap to the forefront of management. Based on the Javelin II (previously treated patients) data, the FDA approved the use of Avelumab for patients with advanced MCC regardless of prior therapy in May ...
What adjuvant chemotherapy is preferred in primary ovarian mucinous adenocarcinoma of intestinal type?
Mucinous ovarian cancers are rare (3-4%) and are distinct from high grade serous ovarian cancers. Many of our trials for adjuvant chemotherapy in ovarian cancer only included small percentages of patients with mucinous histology (typically less than 5% entered in trials). While serous tumors tend to...
How would you treat a younger patient with relapsed mantle cell lymphoma after treatment with hyperCVAD?
In front line therapy for MCL patients, induction followed by ASCT should be the standard of care followed by rituximab maintenance and follow up for MRD.In relapsed MCL, after anthracycline and cytrabine containing therapy, BTK inhibitors appear to be the most affective agents.Results of a pooled a...
Is there a role for temozolomide in patients with Stage IV NSCLC with leptomeningeal disease who have progressed on first line chemo-immunotherapy?
I've tried it and have never been impressed with it. The only treatments that I've ever seen convincingly work for LMD in NSCLC is in patients with actionable mutations treated with brain-penetrating TKIs.