Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Are there known biomarkers predictive of response or resistance to sacituzumab govitecan which should be incorporated into treatment decisions for metastatic TNBC?
In the ASCENT trial, we evaluate the association between Trop-2 expression and clinical outcomes. Overall, the median progression-free survival (PFS) was 6.9, 5.6, and 2.7 months for high, medium, and low Trop-2 scores, respectively with SG compared with 2.5, 2.2, and 1.6 months with standard chemot...
For a young patient who had a prior pCR to neoadjuvant therapy, would you consider systemic therapy after local resection and radiation of an isolated brain metastatic recurrence of triple negative breast cancer?
We have had prior discussions about this clinical scenario and there was a range of opinions due to the lack of definitive data in this space. Many felt that if a patient was NED after the resection that they could be observed as some patients can remain so with no further systemic therapy. I think ...
Would you consider PARP inhibition in a patient with metastatic prostate cancer and a germline BRCA2 variant of unknown significance?
Over 90% of BRCA2 variants of undetermined significance in the past have been reclassified as benign variants, and thus VUS's should be treated as non-pathogenic and should not lead to a change in therapy and would not be predicted to be PARP responsive. It would be reasonable to confirm the signifi...
Would you re-challenge a patient with refractory multiple myeloma with carfilzomib who responded well but developed grade 3 heart failure and subsequently recovered the EF upon holding carfilzomib?
I avoid rechallenging and try to find a different regimen if applicable. If Carfilzomib was the only option left for RRMM, then you might consider a dose reduction with close follow up with cardio-oncology to optimize HF medications.
How does the presence of ascites affect your treatment planning for SBRT for HCC?
This is not an unusual situation in clinical practice, as it is common for HCC patients to have both benign and malignant liver disease. It is important to weigh the risks of aggressive SBRT in the setting of malignant ascites. In my practice, I find it is rarely the appropriate option. However, if ...
Are you comfortable using DOACs in obese patients with VTE?
Although there are no direct randomized trials in this population of patients, emerging data from systematic reviews suggest that DOACs are non-inferior to warfarin in patients >120 kg. (Elshafei et al., PMID 32556939).
How would you manage a localized melanoma of the anal canal with sphincter involvement, but without nodal or distant disease?
Anorectal melanoma is a rare entity and I have very limited experience. I summarized my experience in a different question on this forum "How would you approach a patient with clinical T3N1 anorectal malignant melanoma referred by a surgeon for neoadjuvant therapy?" For this patient in question, who...
What's the optimal management of stage IA nodal ATLL in a young fit patient?
It is a difficult question to answer. More data is needed to give recommendations: LDH, Ca, circulating ATL, lymphocytosis, etc. as it will be useful to sub-categorize her disease as lymphoma-type vs. chronic-type (favorable or unfavorable). It looks like you are treating her as a lymphoma-type whic...
How do you approach a patient with an anaplastic plasmacytoma without systemic evidence of disease in the bone marrow?
I'm not sure what an anaplastic plasmacytoma is. Is it a plasmacytoma that is made up of amorphous cells that express CD138, are clonal, and don't express EBER, ALK, or HHV8? This seems to follow along the lines of what is a plasmablastic neoplasm. If there are no clonal plasma cells in the marrow, ...
How would you manage adjuvant treatment of a premenopausal woman with HER2 positive, ER/PR negative multifocal micro-invasive node-negative breast cancer?
I would not typically recommend any adjuvant chemotherapy + HER2 directed therapy for a T1mi N0 breast cancer. For T1a, the risk of distant recurrence also is likely low based on observational series, so observation is also reasonable. However, as per NCCN guidelines, it is also appropriate to consi...