Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How do you approach non-surgical patients with GIST who are intolerant to imatinib 400 mg daily and unlikely to tolerate other TKIs?
Great question! I usually try splitting it first: 200 in the am and 200 in the pm. I also aggressively manage side effects. If still a problem, I may have to reduce the dose.
How do you approach patients with Stage IIIB/C NSCLC with ipsilateral supraclavicular (N3) disease?
Concurrent CT/RT followed by durva if no PD or pneumonitis.
Do patients with Stage III unresectable NSCLC with lepidic features require a different approach to chemo-radiation?
For limited stage SCLC with curative intent, do you ever substitute carboplatin for cisplatin in concurrent CRT setting?
Based on the COCIS meta-analysis of carboplatin versus cisplatin-based chemotherapy of SCLC which included patients getting radiotherapy for limited-stage disease (Rossi et al, JCO 2012), there was no evident survival advantage with cisplatin overall. In multivariate analysis, there appears to be tr...
Does the final report and approval of CHECKMATE 227 (ipi/nivo) regimen change your first line recommendations for patients with PDL1 TPS < 1%?
Not at this point. There are many factors that should be considered when treating patients with a PD-L1 < 1%. A recent analysis (page 372, MA25.01) of KEYNOTE 407, 021, and 189 indicated that patients receiving chemotherapy + pembrolizumab had improved survival compared to those receiving chemothera...
How would you approach a young patient with ER+/Her2- bilateral breast cancer with a solitary bone metastasis?
I'm assuming from the question that this is a de novo Stage IV. Assuming a biopsy confirms metastatic breast cancer, I'd start such a patient on the appropriate endocrine therapy. I'd wait on considering loco-regional therapy until there has been a response. This reduces the risk of pursuing loco-re...
How would you manage a postmenopausal female with a history of early stage invasive ductal ER+/HER2- breast cancer s/p mastectomy who has a local recurrence of ER+/Her2 - lobular carcinoma while on letrozole?
I am sure most of us would offer local resection and radiation therapy along with staging work up without consideration for chemotherapy given CALOR data showing no benefit in ER positive cases. The final analysis of CALOR does not support the use of chemotherapy for ER-positive isolated loco-region...
Is there a role at this time for chemo-immunotherapy in the upfront treatment of classic Hodgkin lymphoma?
Would you consider off label use of olaparib maintenance in patients with somatic BRCA1 mutated pancreatic adenocarcinoma?
In addition to the comments above, it is worth observing that preliminary prospective data addressing this question was presented at AACR this year by @Dr. First Last. Her group is evaluating the role of rucaparib maintenance for patients with either germline or somatic BRCA or PALB2 mutations. Of t...
Would you re-introduce bisphosphonate or denosumab in a bone-only metastatic ER+ breast cancer patient with history of osteonecrosis of the jaw?
The ASCO, ADA, and Maxillofacial surgeon society guidelines on osteonecrosis of the jaw do not directly address this scenario. The antiresorptive effects of bisphosphonates persist for a long time after cessation due to a long half life in the bone. This is not the case with denosumab. Also bisphosp...