Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
What is your preferred treatment for a resected composite hemangioendothelioma of the skin arising from a childhood hemangioma?
Close observation would be most reasonable. Reoperate if there is a recurrence. Does not seem to conform to any specific genetic predisposition syndrome, but testing through a Geneticist can't hurt.
How do you approach the re-challenge with trastuzumab in metastatic HER2+ patients who develop cardiomyopathy on trastuzumab/pertuzumab with subsequent improvement with discontinuation?
First, I send all my patients in this situation to the cardiologist. Second, I will re-start the treatment with close cardiology follow-up. Whether to re-load or not is an open question. I personally do not re-load, but I don’t think is wrong to re-load.
How do you decide whether to obtain dental evaluation to reduce the risk of medication-related osteonecrosis of the jaw prior to initiating non-urgent bone-modifying agent therapy?
I have a practice that I send all patients, even edentulous patients, for a dental screening examination if they have a non-emergent need bone-modifying agents (BMAs). That recommendation comes from osteonecrosis guidelines published in J Clin Oncol 2019. The reason for this recommendation is when s...
Would you consider low dose lenvatinib or dabrafenib/trametinib for rapidly progressive RAI refractory thyroid cancer with BRAF V600E mutation in a patient in whom you are concerned about tolerance of full dose lenvatinib?
I would start with lower doses of Dabrafenib (50 mg BID) and Trametinib (0.5 mg QD) and increase doses as tolerated. I institute Lenvatinib if they fail Dabrafenib and Trametinib. It is not unusual for me to start Lenvatinib at 10 mg daily. But I do not give more 20 mg daily dose.
In patients with metastatic colon cancer responding to treatment with FOLFOX / FOLFIRI with bevacizumab who develop a symptomatic PE, do you continue bevacizumab after treating the PE?
Do we need to continue dose escalations wtih DA REPOCH after a negative interim PET scan for PMBCL?
What is your preferred salvage chemotherapy regimen for bridge to auto SCT for patients with relapsed classical Hodgkin Lymphoma?
We actually have been favoring using a bendamustine-brentuximab based regimen (in those who have not received brentuximab in the front line setting). Supportive data is based on Lancet Oncol. Feb 2018 that showed a favorable toxicity profile with an almost 80% ORR. Usually will give 2-3 cycles, rest...
Would you discontinue dabrafenib/trametinib in a patient with BRAF mutant metastatic lung cancer if you see mild cardiomyopathy which could be related to the drugs?
This is a good question and a clinical scenario that I just recently ran into. The main question relates to the degree of LVEF change and whether the patient is symptomatic or not. It is not that uncommon overall. In the phase 2 trial of dabrafenib and trametinib that led to approval of this regimen...
How do you think about management options in a patient with a minute focus of Gleason grade 4 (4+4) on 1 core from needle biopsy along with only Gleason 3+3 disease in other biopsy cores and PSA<10?
This patient has "Favorable High Risk Prostate Cancer", and has outcomes similar to an intermediate unfavorable risk patient, rather than a true high risk patient. See here.I would offer this patient at least 6 months of ADT with IMRT. It would not be wrong to offer a longer course of ADT (24 mo), b...
For rectal adenocarcinoma initially staged as T2N0 and treated with upfront surgical resection, but pathologically upstaged to pT3N0 without high risk features, how do you approach adjuvant therapy?
It is not uncommon for a rectal cancer which was initially felt to be T1-2 and node negative to be revealed to be more advanced stage after surgery. To know what to do in these settings, we have to go “old school” and revisit trials reported in the 1990s, combined with lessons learned in the 2000s.S...