Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How do you manage patients with oligometastatic renal cell carcinoma after nephrectomy and metastatectomy?
Patients with oligometastatic renal cell carcinoma after nephrectomy and metastatectomy or M1 NED represent a challenging subset of patients given the heterogeneous nature of this subset and outcomes vary with the location and timing of metastatectomy.Prior VEGF-TKI studies after metastasectomy for ...
How long do you wait before performing liver-directed therapy on a colon cancer patient with liver-only disease and prior radiation-induced liver injury ?
What is the optimal duration for denosumab use in the setting of recurrent, un-resectable giant cell tumor?
Additional comment: There were plans to test intermittent maintenance dosing (q 3 months) after a year of monthly treatments in a randomized trial which unfortunately never materialized, so there is no data/evidence, but not an unreasonable alternative to try.
Would you offer adjuvant hormonal therapy to elderly men with strongly HR+ DCIS after mastectomy?
Yes, I would offer adjuvant endocrine therapy to reduce contralateral breast DCIS recurrence risk, preferably tamoxifen, extrapolating from female breast cancer data.Sharon Giordano, PMID 29897847
How do you manage maintenance therapy in metastatic NSCLC, adenocarcinoma with good response to initial chemo (carboplatin, pemetrexed, pembrolizumab) with borderline renal function that has worsened during initial treatment?
This is a difficult situation as it may not be possible to discern if creatinine elevation is related to pemetrexed versus immune checkpoint inhibitor (ICI)-nephritis; therefore, nephrology assessment would be crucial.I assume the question is regarding patients with significant renal impairment (i.e...
In metastatic TNBC with germline or somatic BRCA mutation, when is the preferred time to introduce a PARP inhibitor?
First line PARPi for a gBRCA mutated metastatic TNBC should be considered if the PDL1 expression is too low or clinical considerations preclude 1st line checkpoint therapy. After the PARPi in this situation, I would consider sacituzumab or a clinical trial with other DNA damage response targeting ag...
When, if ever, would you use aflibercept instead of bevacizumab in the treatment of colorectal cancer?
For oncology indications (vs ophtho), I would only use it if it is the only VEGF inhibitor available to me (due to insurance issues or hospital formulary). I see no advantage to it over bevacizumab otherwise.
What options are available for patients with relapsed/refractory AL amyloidosis after Dara-CyBorD, other than clinical trial?
No great answers, unfortunately. Lenalidomide still tends to make me a bit nervous in AL amyloidosis, as does carfilzomib in patients with known cardiac involvement. But pom-based regimens are an option, or carfilzomib-based in the appropriate population.If the patient's BMBx shows t(11;14) by FISH,...
How do you approach management of non-resectable periampullary adenocarcinoma in an elderly patient with otherwise good PS?
The level of evidence is more limited to guide treatment decisions for ampullary/peri-ampullary adenocarcinoma compared to the neighboring pancreas. However, I have generally approached this situation similarly to locally advanced or inoperable pancreas cancer starting with systemic therapy and if t...
What is your process for assessing the "high risk" clinical features in gBRCA+ breast cancer in order to offer olaparib, given varying definitions of risk and recent changes in staging guidelines?
I follow the criteria used in the eligibility for the OlympiA trial to determine who I will offer olaparib to in the adjuvant setting, which is consistent with the ASCO Hereditary Breast Cancer Guideline Rapid Recommendation Update.In patients with gBRCA+ breast cancer who received at least 6 cycles...