Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How do you approach a patient with recurrent VTE who develops VTE again after reduction of apixaban to 2.5 mg bid?
Several factors play into this decision for me. Is the patient obese? Obese patients tend to give me pause for dose-reduction of DOACs. As such, half-dose apixaban may have been relatively underdosed for an obese patient and I would not call it DOAC failure, rather I would increase the dose to usua...
How do you approach adjuvant therapy for resected Stage I Ewing sarcoma of the kidney?
From a chemotherapy standpoint, all stages of Ewing Sarcomas are approached the same way. There are differences in surgical approach between localized disease versus metastatic disease. We give VAC alternating with IE for six cycles, each. Since this is resected, this regimen should be given in the ...
How well does a negative non-contrast MRI of the brain exclude metastasis in a patient with squamous cell carcinoma of the lung?
I don't think the question has enough information to give a good answer. For example, if it was a T3, N2 NSCLC, or a small cell, then "yes" I'd repeat the MRI with contrast. On the other hand, if it was a T1, N0 NSCLC, then "no", I wouldn't. In other words, if I thought there was a real risk of havi...
What is your approach to adjuvant endocrine therapy in hormone receptor positive male breast cancers?
Tamoxifen should be the standard adjuvant endocrine therapy for ER+ breast cancer in men. There has been talk intermittently about aromatase inhibitor (AI) use as alternative endocrine therapy, and I would not recommend the use of AIs in this setting. Data is limited, with the one study comparing ou...
What imaging surveillance for ILD do you utilize for patients with HER2+ breast cancer receiving adjuvant T-DXd?
I follow the protocol as described in DESTINY-Breast05 (Loibl et al., PMID 41370739):For patients who received adjuvant radiotherapy, monitoring for asymptomatic or mildly symptomatic therapy-related interstitial lung disease or pneumonitis included serial low-dose CT of the chest at 6 weeks after t...
Do you always send SDHB by IHC for workup of GIST or is NGS that includes SDHB sufficient?
In the appropriate clinical presentation, with negative KIT and PDGFRA, NGS that includes SDH should be sufficient to define the entity.
What is your approach to recurrent metastatic high-grade uterine carcinosarcoma with rhabdomyoblastic differentiation?
Carcinosarcomas (even with rhabdomyoblastic differentiation) are still considered to be derived from endometrial tissue. I would treat it as endometrial cancer and not as uterine or soft tissue sarcoma.
Would you consider circulating DNA assay in resected node-negative deficient MMR colon cancer off-trial to guide your treatment?
Hello. It appears you are asking about a stage II MMR deficient/MSI-High colon cancer. The recurrence rate for stage II mismatch repair deficient (dMMR) colon cancer is generally lower than that for mismatch repair proficient (pMMR) tumors. Studies have shown that the 5-year recurrence rate for stag...
What is your approach to systemic therapy in newly diagnosed colon cancer with synchronous solitary liver metastases?
This is an important and challenging clinical question. In general, I favor a neoadjuvant chemotherapy treatment approach for a variety of reasons. For one, the EORTC trial provides us with supportive data that perioperative FOLFOX is associated with a modest improvement in outcome compared to surge...
If a BRAF-mutated melanoma patient developed metastatic disease progression on adjuvant anti-PD-1 monotherapy, do you recommend switching to BRAF/MEK targeted therapy or combination immunotherapy?
The developing pre-clinical and clinical data is clear on this and I believe it becomes even more clear with time. While the DREAMseq study did not enroll patients following adjuvant therapy as the patient in the case, the overall evidence clearly shows that BRAF/MEK inhibitor resistant melanomas ar...