Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Is there any clinical benefit in giving Tamoxifen in a pre-menopausal woman with early stage breast cancer who initially refused adjuvant hormone therapy for years?
I would think that there would be clinical benefit to giving tamoxifen in a delayed fashion to a patient who initially refused adjuvant therapy, but this is not exactly a "data-driven" reply given that we do not have trials analyzing this particular situation.Data indicates that recurrence risk of h...
How do you counsel a young woman carrying a BRCA 1 or 2 mutation and history of breast cancer who desires pregnancy?
Pregnancy subsequent to breast cancer does not worsen the prognosis. If a young BRCA carrier desires to become pregnant she should be supported. Points to emphasize: 1) the rates of ovarian cancer don't begin to rise until after 35 years; 2) she can be screened by breast ultrasound during pregnancy;...
How would you treat recurrent parotid gland carcinoma with unresectable, metastatic disease?
It depends on the histology. Salivary ductal carcinomas are often HER2 positive, and I have had some success treating with HER2 targeted regimens. Secretory carcinomas often have NTRK fusions, and should be enrolled on clinical trials with NTRK inhibitors if possible (Drilon A et al, NEJM, 2018). Fo...
When would you consider neratinib in a patient with locally advanced HR positive, Her2 positive breast cancer who received one year of trastuzumab and pertuzumab?
There is no data on adjuvant neratinib following one year of trastuzumab and pertuzumab. However, as the added benefit of pertuzumab to herceptin in HR pos HER2 pos is minimum in the adjuvant setting, I would consider neratinib in high risk patients, for example being node positive.
Do you ever consider hormone replacement therapy in a woman who is suffering from early menopause that has been likely cured of her breast cancer and undergone bilateral mastectomies?
A short period of HRT is OK The fact she has or has not had a bilateral mastectomy does not change my answer
Would you offer Durvalumab as consolidation therapy to a patient with stage III NSCLC but had local recurrence treated with definitive SBRT?
This very relevant and highly challenging question brings to mind Osler’s quote: "Medicine is a science of uncertainty and an art in probability". How do we apply the data that we have to the individual patient in front of us needing our best counsel? How do we apply the now more mature (see prior...
What is your approach to CMV prophylaxis in the post-allogeneic stem cell transplant setting?
We do not routinely use letermovir but we are looking carefully at this data. We use prophylactic ganciclovir pre transplant and high dose acyclovir post transplant in high risk patients and are reviewing this data as well.
How do you utilize lenalidomide maintenance in non-transplant eligible myeloma?
Maintenance is a standard of care management for both transplant eligible and transplant ineligible, regardless of type of induction regimen. Studies have shown benefit for both groups. Time to progression (PFS) almost twice as long for both groups with maintenance compared to no maintenance. - For ...
For pre-menopausal female patients who present with acute leukemia in need of urgent anti-neoplastic therapy, what is your preferred approach in effort to preserve fertility?
This patient would be a good candidate for ovarian tissue cryopreservation (OTC), since time would be limited to stimulate and retrieve oocytes. One can complete OTC with line placement and other procedures and be able to start chemotherapy the day after OTC. I know not every center has access to OT...
How would you approach distant oligometastatic HPV positive oropharyngeal cancer previously treated with definitive local therapy?
Patients who present with a single focus of disease outside of their local regional disease, technically have stage IVC (i.e. widespread metastatic) disease. Such patients could be offered a palliative course of RT to their locally advanced disease followed by systemic chemotherapy; however, given t...