Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How would you approach a patient with Li Fraumeni syndrome and a mucinous anal adenocarcinoma with inguinal node metastases?
The safe dose of radiation in this setting is not known. There is not much published about it in Li Fraumeni patients. Mucinous adenocarcinoma suggests low rectal cancer as opposed to adeno of the anal canal. Either way, we would treat this like rectal cancer. At our institution we would use nonoper...
Would you retreat a patient with docetaxel for metastatic castrate resistant prostate cancer if treated in hormone sensitive setting (metastatic disease) with good response three years ago but now has CRPC and has progressed on abiraterone?
If the patient had a favorable response (presumably in setting of metastatic hormone sensitive prostate cancer), and it was well tolerated w/o evidence of chronic toxicities such as neuropathy I would definitely use docetaxel again. There is historic evidence for a docetaxel holiday in the metastati...
How do you approach a patient who responded to first line osimertinib but develop an isolated progressing lesion that retains sensitizing EGFR mutation but develops MET amplification?
Radiate single site and continue OSI. Repeat liquid biopsy at next progression.
How would you approach a post-menopausal woman who now wishes to start adjuvant endocrine therapy more than 3 years since surgery?
The short answer is yes. You start endocrine therapy even if it is late. It is important to remember that events in this disease occur later and very few events occur in the first few years anyway. Like starting any treatment, it is a good idea to weigh risk of recurrence and value of treatment, es...
How do you approach non-surgical patients with GIST who are intolerant to imatinib 400 mg daily and unlikely to tolerate other TKIs?
Great question! I usually try splitting it first: 200 in the am and 200 in the pm. I also aggressively manage side effects. If still a problem, I may have to reduce the dose.
How do you approach patients with Stage IIIB/C NSCLC with ipsilateral supraclavicular (N3) disease?
Concurrent CT/RT followed by durva if no PD or pneumonitis.
Do patients with Stage III unresectable NSCLC with lepidic features require a different approach to chemo-radiation?
For limited stage SCLC with curative intent, do you ever substitute carboplatin for cisplatin in concurrent CRT setting?
Based on the COCIS meta-analysis of carboplatin versus cisplatin-based chemotherapy of SCLC which included patients getting radiotherapy for limited-stage disease (Rossi et al, JCO 2012), there was no evident survival advantage with cisplatin overall. In multivariate analysis, there appears to be tr...
Is there any role for "adjuvant" therapy for completely resected oligometastatic RCC?
The data re: adjuvant therapy for either high risk (bulky or node positive primary renal cell cancer) or completely resected metastatic renal cell cancer (either synchronous or metachronous) remains largely negative. Trials conducted with cytokines or with a variety of multi kinase inhibitors (sunit...
Does the final report and approval of CHECKMATE 227 (ipi/nivo) regimen change your first line recommendations for patients with PDL1 TPS < 1%?
Not at this point. There are many factors that should be considered when treating patients with a PD-L1 < 1%. A recent analysis (page 372, MA25.01) of KEYNOTE 407, 021, and 189 indicated that patients receiving chemotherapy + pembrolizumab had improved survival compared to those receiving chemothera...