Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Do you check baseline or surveillance audiometry (if not overtly symptomatic) to screen for hearing loss in all patients getting cisplatin?
I disagree. When we started testis studies in 1974 with PVB, we did baseline audiometry and repeated it at 9 weeks, 3 months and 6 months. Everyone experiences a certain degree of high frequency hearing loss which is usually reversible. During the past 40 years we NEVER get baseline audiometry as te...
How would you approach a patient with localized breast cancer who had a low Oncotype Dx recurrence score but a 20% risk of distant recurrence (without chemotherapy)?
The question asks how to treat a patient with a low Oncotype Dx score, but an estimated risk of recurrence of 20% without chemotherapy. I am presuming the estimated recurrence risk is based on clinical parameters, such as tumor size and grade, independently from the molecular profiling data. If this...
How do you treat a composite NHL of various subtypes?
There is no single answer here because composite lymphomas are highly varied and variable. The general principles here are to treat the component disease most in need of treatment, as best you can, and not to sacrifice curative intent for an aggressive curable component. For the case of composite ag...
Would you hold off on whole brain radiotherapy for a patient with metastatic NSCLC and multiple asymptomatic brain metastases and will be starting immunotherapy?
This is a very controversial area right now (as are most MedNet queries!). Given the data available and the opinion pieces by thought leaders right now on immunotherapy results in melanoma brain metastases, it would be very reasonable to hold off on WBRT for patients with asymptomatic melanoma brain...
What is your preferred maintenance therapy in young, fit patients with de novo plasma cell leukemia who achieve complete response after autologous stem cell transplantation?
Plasma cell leukemia is routinely excluded from post-transplant maintenance studies, so we cannot look to any of the randomized maintenance studies performed over the past decade. I would consider plasma cell leukemia to fit into the category of ultra-high risk myeloma, and would use lenalidomide pl...
Is there a preferred sequence of therapy in renal cell carcinoma?
For many years, sunitinib and pazopanib have been the standard first line therapy for metastatic clear cell RCC. A new treatment paradigm is now evolving. Longer overall survival and higher response rate of nivolumab/ipilumimab and pembrolizumab/axitinib combinations vs. sunitinib were demonstrated ...
How would you approach a patient with Li Fraumeni syndrome and a mucinous anal adenocarcinoma with inguinal node metastases?
The safe dose of radiation in this setting is not known. There is not much published about it in Li Fraumeni patients. Mucinous adenocarcinoma suggests low rectal cancer as opposed to adeno of the anal canal. Either way, we would treat this like rectal cancer. At our institution we would use nonoper...
Would you retreat a patient with docetaxel for metastatic castrate resistant prostate cancer if treated in hormone sensitive setting (metastatic disease) with good response three years ago but now has CRPC and has progressed on abiraterone?
If the patient had a favorable response (presumably in setting of metastatic hormone sensitive prostate cancer), and it was well tolerated w/o evidence of chronic toxicities such as neuropathy I would definitely use docetaxel again. There is historic evidence for a docetaxel holiday in the metastati...
How do you approach a patient who responded to first line osimertinib but develop an isolated progressing lesion that retains sensitizing EGFR mutation but develops MET amplification?
Radiate single site and continue OSI. Repeat liquid biopsy at next progression.
How would you approach a post-menopausal woman who now wishes to start adjuvant endocrine therapy more than 3 years since surgery?
The short answer is yes. You start endocrine therapy even if it is late. It is important to remember that events in this disease occur later and very few events occur in the first few years anyway. Like starting any treatment, it is a good idea to weigh risk of recurrence and value of treatment, es...