Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Are there any data for second line nivolumab-ipilimumab in patients with metastatic NSCLC treated with either single agent pembrolizumab or chemotherapy + ICI as first line therapy?
Resistance to PD-(L)1 inhibitor based first line therapy and choice of subsequent treatment for patients with advanced NSCLC is an ongoing challenge. While addition of CTLA-4 inhibitor to PD-1 inhibitor has shown additive anti-tumor activity via complementary mechanisms of action, it is currently un...
How will you decide among the options of either carbo/gem>avelumab or checkpoint monotherapy for cisplatin-ineligible PD-L1 expressing urothelial carcinoma?
The KEYNOTE 052 data as well as other datasets support the idea that there are clearly a subset of previously-untreated cisplatin-ineligible metastatic urothelial cancer patients who receive benefit from front-line immunomonotherapy and can be treated with this approach. Importantly, responding pati...
What strategies have you found to be most effective in engaging PCPs in a primary-care or shared-care model of survivorship for pediatric and AYA patients who will receive ongoing care in their communities away from their primary oncology treatment site?
This is a challenge for our center, and many other centers as well. The ideal approach would be to have adult primary care physicians associated with our center who have dedicated clinic time to care for cancer survivors, direct access to our expertise and medical records. While we haven't been succ...
Will you offer adjuvant olaparib to patients with somatic BRCA mutated breast cancer given that OlympiA only enrolled germline BRCA+?
I agree that the 3-year DFS benefit is quite compelling for considering adjuvant olaparib in patients meeting the eligibility criteria in NSABP B55 (Tutt et al., PMID 34081848). This also raises the possibility of clinical benefit in other scenarios, particularly those where PARPi have shown meaning...
How would you sequence 177LU-PSMA-617 with current therapies for men with mCRPC?
I would like to congratulate the VISION study investigators and Dr. @Dr. First Last for the outstanding presentation and good news. The study was designed to use a hybrid control (best "standard of care"-SOC) and as such, it met its endpoints (OS, rPFS, etc). Secondary endpoints also significantly f...
What neoadjuvant chemotherapy would you consider for squamous cell carcinoma arising from a ruptured tailgut cyst?
Tailgut cysts are congenital lesions that develop from tailgut embryonic remnants. Though malignant transformation has been described, literature is largely limited to case reports. I would ensure the patient has been adequately staged with PET/CT and/or MRI of the pelvis. If resectable, I would adv...
Are there any clinical scenarios in which you would treat BRCA mutated HER2 negative metastatic breast cancer with a PARP inhibitor in combination with carboplatin?
There is a large prospective phase III study that showed a significant improvement in DFS for veliparib+carbo+ paclitaxel versus carbo+paclitaxel (BROCADE3 study; Dieras V et., PMID 32861273).
How would you manage anastomotic site recurrence of colon cancer 3 years after resection of a T3N0 tumor without high-risk features?
I will do metastatic work up. If negative:- FOLFOX.
Is it acceptable to treat pediatric Hodgkin's lymphoma with an involved nodal field outside the setting of a clinical trial?
It probably is. Although not proven by randomized trial/s in pediatric patients, the practice is accepted in adults. In children where long term morbidity of radiation therapy is of greater concern, it would not be unreasonable to use involved nodal field in combination with chemotherapy.
Is it preferable to simulate pediatric Hodgkin's lymphoma patients with arms up or akimbo?
We will be moving towards involved site radiotherapy for pediatric Hodgkin lymphoma. Consequently, you may want to match the simulation with the set up of their pre-treatment PET/CT scan (arms up vs arms down). This will allow you to have more certainty regarding the location of axiallary and subpec...