Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How would you approach therapy for BR-refractory Waldenstrom Macroglobulinemia when there is a mixed response to zanabrutinib?
It goes without saying this is a “data-free zone.” I would consider extrapolating from CLL and adding venetoclax.
What would you offer postoperatively for a pt with resected 3 separate HPV+ SCC primaries with pN1 disease with ECE who is cisplatin ineligible?
In view of this patient having ECS and three primaries (including bilateral disease), I would definitely treat postoperatively with chemotherapy in conjunction with radiation therapy. I still favor a platinum-based regimen in view of this patient's neurological toxicity due to previous cisplatin exp...
What are your recommendations for a patient with metastatic non-mutated lung adenocarcinoma who previously had headaches responsive to prednisone but with negative temporal artery biopsy for GCA?
GCA is often a challenging diagnosis to make in the absence of objective findings of halo sign, pathologic evidence of vasculitis, or large vessel vasculitis on imaging. Headache of any type will often respond to prednisone so the first step, in this case, is to determine if the patient truly has GC...
How are you approaching patients with Stage IV EGFR NSCLC who progress on first line TKI and are found to have retained EGFR mutation as well as MET amplification?
The nuance here is how the MET amplification was detected and defined. Was it through an NGS platform (such as Guardant) or through FISH-based testing? If the latter, what was the MET gene copy number, and what was the ratio of MET/CEP7?Nonetheless, assuming MET amplification is an accurate bypass s...
How do you sequence therapy in an older patient with newly-diagnosed blastoid mantle cell lymphoma with a 17p deletion?
Tricky question. There are two issues, 1. the morphology and 2. depending on how you evaluate a 17p deletion. The deletion in literature isn't as clearly associated with poor outcomes as compared to mutations. Given that there are two copies, as long as one allele is still present then would still h...
Do you offer neoadjuvant FOLFOX for elderly patients with locally advanced rectal cancer receiving short course radiation?
I would approach this case somewhat analogously to the bulk of cases of locally advanced rectal cancer by first getting an understanding of the patient's physiologic age/functional status, surgeon’s opinion on operability and concern for margins, and imaging-defined risk factors- location of tumor a...
In which cases would you use adjuvant abemaciclib for a patient with extensive residual disease that is triple-positive (ER+PR+HER2+) following neoadjuvant TCHP?
There is no evidence that adjuvant abemaciclib benefits the HR+ HER2+ setting. The biology between HR+ HER+ and HR- HER2+ is quite different.
Is there a role for adjuvant capecitabine in sequence with abemaciclib for high risk HR+ breast cancer with residual disease?
Several randomized trials and meta-analyses have failed to show the benefit of adding capecitabine in Neo-adjuvant or adjuvant setting, except for selected TNBC patients. GEICAM/2003-10 and FinXX are few of those well-conducted studies that explored the addition of capecitabine in early stage breast...
How do you approach therapy for a patient with stage IIIA NSGCT who received 4 cycles of EP followed by RPLND which revealed residual mixed teratoma and embryonal carcinoma?
This is a query that can never be answered by evidence based medicine. Instead, all we have is (very old) historical data and perhaps common sense and logic. In 1974, we initiated our phase II study of PVB, with 4 courses of induction chemo followed by 2 years of maintenance vinblastine. That was ou...
How would you treat a patient who got three months of adjuvant CAPOX for T4N0 stage II colon cancer, but had a solitary pulmonary metastasis a year later which was resected?
For metastasectomy where they have had prior chemotherapy in an adjuvant setting, I would not routinely recommend more chemotherapy. See for example (although there have recently been several studies supporting this approach). Bosma et al., PMID 34420823. Consider using ctDNA for surveillance as par...