Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
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...
Is there any role for neoadjuvant chemotherapy in renal leiomyosarcoma?
Contributing factors in this decision would include size, feasibility of organ preservation, and patient's PS/organ function. The regimen with some activity would include the combination of doxorubicin and dacarbazine.
For patients with myeloma on an IMiD, how do you decide on the dosages of aspirin or anticoagulants in VTE prophylaxis ?
The phase III trial by Palumbo et al., PMID 21282540 is still the only prospective randomized trial of VTE prophylaxis in MM with "standard" thromboembolic risk patients eligible for IMiD treatment. In this study, administration of 40 mg enoxaparin was compared with fixed dose of 1.25 mg warfarin...
Would you consider addition of docetaxel to abiraterone and ADT in metastatic hormone senstive prostate cancer patients who progress on ADT and abiraterone?
The question is incorrectly phrased, when a patient progresses on ADT and Abi they are not hormone sensitive. In patients with high risk metastatic prostate cancer, I would not add docetaxel to abi and ADT yet as OS data has not matured. However, I do sequence them in a select group of high risk pat...
Would you treat a patient with non-clear cell renal cell carcinoma with nivolumab and ipilimumab?
What is your approach to patients with unresectable, node-negative perihilar cholangiocarcinoma who have undergone biliary stenting and have no evidence of distant disease?
For perihilar cholangiocarcinoma that has been deemed unresectable by hepatobiliary surgeons, a good consideration is to have the patient evaluated for liver transplantation. The Mayo Clinic protocol allows tumor mass of <3cm, no nodal disease, and vascular involvement is allowed. Depending on the f...
How does the updated classification system of gliomas impact your recommendations for radiation?
Minesh Mehta and @Dr. First Last, Miami Cancer Institute In 2021, the World Health Organization (WHO) introduced significant new changes to the classification of tumors of the central nervous system (CNS) in their 5th edition (WHO CNS5) (Louis et al., PMID 34185076). This step was the first of many ...
For metastatic prostate cancer, when would you add carboplatin to docetaxel or cabazitaxel?
There is no clear consensus on this topic. However, I consider carboplatin plus docetaxel or cabazitaxel in men with the following features who are fit for chemotherapy and wish to be aggressive in their care, based on Paul Corn's MD Anderson trial (PMID 31515154): Aggressive variant phenotypic feat...