Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How would you approach therapy for newly diagnosed germinal-center DLBCL who previously received an unknown systemic regimen with radiation for history of Hodgkin Lymphoma?
A lot of times, you can ask the patient if they received a red medication (doxorubicin) or if their hair fell out to determine prior anthracycline exposure. If you cannot confirm, I would assume that they received ABVD x 6 cycles. This would be a cumulative drug exposure of 300 mg/m^2. Depending on ...
For a patient with metastatic gastric adenocarcinoma with CT showing NED after 4 months of FOLFOX + pembrolizumab + trastuzumab, would you consider resection of the primary and/or a chemo break?
This question is about a patient with gastric cancer who has a complete response to therapy with chemotherapy, trastuzumab, and checkpoint inhibitor blockade. The patient had a radiographic CR after 4 months of therapy. How to proceed from here is an interesting question, and would be influenced by ...
How would you approach a patient with well controlled metastatic lung cancer who develops a new primary P16 positive oropharyngeal squamous cell carcinoma?
Multiple primaries are not uncommon. Given tremendous advances in treatments of advanced lung cancer and consequent improvement in overall survival, it is important to focus on screening, early detection, and curative-intent of other cancers whenever applicable. This seems to be one such situation. ...
Would you consider de-escalating abiraterone in a patient treated with ADT/abiraterone/prednisone for metastatic hormone sensitive prostate cancer who has had an excellent response with undetectable PSA and minimal side effects for over 2 years?
Wonderful question. There really is no data to guide this question. Some people are wondering about de-escalation of therapy from the start vs super escalation (triple therapy) for other patients. This strategy makes biologic sense. Match the therapy to the biology of the cancer. The challenge is th...
What are your recommendations for a male patient who was recently started on imatinib and wants to conceive?
Great question. This comes up often. For males, they can continue to take their CML TKI and conceive a child. Of course, this is much more complicated for women as they should not be pregnant while taking a TKI. I would say that if the patient is having difficulties conceiving, he should undergo a ...
Would you consider avoidance of AC and proceeding to surgery in a cT2N0 TNBC patient who achieves a significant clinical response to carboplatin, paclitaxel, and pembrolizumab as part of the KEYNOTE-522 regimen?
Full disclosure -- I trained in breast cancer at UCLA, where we generally avoid anthracyclines. The main downside of adding an anthracycline to a taxane-based regimen is the elevated risk of leukemia, myelodysplasia, and congestive heart failure or weakening of the heart long-term. I use neoadjuvant...
How do you approach borderline non-regional mediastinum lymph nodes when treating locally advanced esophageal cancer?
I basically consider any nodal disease in the mediastinum from esophageal cancer to be operationally regional disease and would include those areas in the radiation fields if feasible. The comment about the nodes being borderline positive is an ambiguity that cannot be resolved in a forum like this....
What schedule and type of antiemetics do you provide for patients receiving PCV for co-deleted oligodendrogliomas?
I give 16 mg ondansetron and 20mg dexamethasone one hour prior to CCNU/lomustine on day 1 and then 8mg dex on days 2 and 3. I do always prescribe ondansetron q8h as needed and give them compazine to have as well, as needed, q6h. I've honestly had most patients not need anything further, but if they ...
Which patients with resectable Stage IB-IIIA NSCLC would most benefit from using neoadjuvant chemoimmunotherapy as per CheckMate 816?
CheckMate 816 enrolled patients with EGFR/ALK wildtype stage IB (>/= 4cm) through IIIA NSCLC, with recent approval from FDA based on improved event-free survival endpoint as well as pathologic complete response rates seen with the combination chemoimmunotherapy compared with standard chemotherapy al...
Would you give ADT + docetaxel -> darolutamide for a low risk castrate sensitive metastatic prostate cancer patient given ARASENS results?
ARASENS was designed during the era of docetaxel plus ADT emerging as the standard of care for men with mHSPC irrespective of disease volume, based on the improved OS observed in STAMPEDE for a largely de novo mHSPC patient population, where there was no heterogeneity observed for the OS benefit in ...