Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How do you treat metastatic renal cell carcinoma with unclassified histology without sarcomatoid features?
There is limited data on optimal treatment of advanced non-clear cell RCC in general, including unclassified RCC. I have summarized the available data that I am aware of: The phase II study ASPEN randomized advanced nccRCC patients, including 20% with unclassified RCC, to sunitinib vs everolimus. Of...
Would you trial a different TKI (vs chemotherapy) if a patient with metastatic EGFRm lung adenocarcinoma developed grade 4 pneumonitis on first line osimertinib?
Presuming patient recovered from grade 4 pneumonitis, there is precedent to switching as reported by clinicians/investigators in Japan wherein EGFR TKI-induced ILD occurs with much greater frequency in this ethnic population compared to the West. As reported by Takeda et al (Japanese Journal of Clin...
What is a preferred regimen for metastatic leiomyosarcoma after failure of doxorubicin/olaratumab and gemcitabine/docetaxel?
What is a preferred regimen for metastatic leiomyosarcoma after failure of doxorubicin/olaratumab and gemcitabine/docetaxel? I would consider treatment with either trabectedin or pazopanib.
How would you manage a patient with esophageal SCC that completed concurrent chemoradiation without definitive surgery with imaging evidence of local progression but biopsies only show focal dysplasia?
What chemotherapy regimen would you recommend to a patient with local regional recurrent ER negative, HER2 positive breast cancer who received TCH more than 5 years ago?
I would treat this patient with chemotherapy and anti Her-2 therapy. Her-2 positive disease has a higher risk of distant recurrence and as long as the primary tumor is >0.5 cm in size, I recommend chemotherapy with anti Her-2 therapy. The type of anti Her-2 therapy and chemotherapy will depend on th...
In transplant-eligible, fit patients with multiple myeloma who have an inadequate response to front-line therapy, what regimen would you choose for second-line?
for transplant eligible patients who you want to get to transplant but have not achieved an adequate response for stem cell collection, there are 3 senarios: 1: if no response at all to front line therapy (VRd) say <PR: would do VDPACE x 2-3 cycles, using the last cycle as chemo mobilization with co...
What is your preferred radiation sensitizing regimen for cisplatin-ineligible patients with locally advanced unresectable p16+ tonsil SCCa?
If patients are not candidates for cisplatin therapy, I personally would consider a carboplatin-based regimen before considering anything else. If the patient's creatinine clearance is > 30 cc/min, I might give Carboplatin (AUC 6) for a T4 or N3 (Stage III) unresectable tumor. Since p16+ tumors do s...
How would you treat a premenopausal woman with triple positive breast cancer that has not had any therapy with a bilirubin of 10mg/dl due to intrahepatic disease?
Your chemotherapy options are limited but you can give some agents like xeloda with herceptin/perjeta as induction then switch her over to endocrine therapy (ofs + AI) plus herceptin/perjeta like the PERTAIN trial. If you can't give her those agents another option that has pulled some patients out o...
Would you consider using a targeted agent as induction therapy outside of clinical trial for a patient with stage IIIB (N2) who may be a candidate for surgical resection and has a targetable mutation?
It’s a data free zone. If the patient is borderline resectable, it may be a reasonable option to try induction TKI for 1mo and re-image and see if the patient can convert to resectable. But there is limited data here. Post op, I would not do adjuvant TKI, but rather chemo or chemoXRT.
How do you decide between continuing 5FU + Chemo (Oxaliplatin or Irinotecan) + Bevacizumab versus switching to maintenance 5FU + Bevacizumab in the first line setting for metastatic colon cancer?
In general, after 4-6 months of induction chemotherapy, if they experience a favorable response, I would favor maintenance chemotherapy based off several clinical trials which have shown a benefit for a maintenance approach, notably OPTIMOX and CAIRO-3. The continuation of oxaliplatin or irinotecan ...