Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
What radiation dose do you typically use for relapsed DLBCL following 6 cycles of R-CHOP?
There are several potential scenarios, all with different answers, so I will illustrate a few.Historically, second-line chemotherapy (e.g., R-ICE) would first be pursued for relapsed DLBCL, and if the disease was still responsive to chemotherapy (CR or PR), then the patient would proceed with high-d...
How do you treat newly diagnosed low volume metastatic hormone sensitive prostate cancer in light of new data from STAMPEDE presented at ESMO 2018?
In the prespecified subset of men with mHSPC and low volume of metastases (CHAARTED criteria of 4 or fewer bone metastases and no visceral metastases), there was a 32% improvement in overall survival (HR 0.68 95% CI 0.52-0.9) which was statistically significant and is clinically significant. Given t...
Given results of the IDEA study presented at ASCO, would you consider truncating adjuvant therapy with stage II colon cancer?
The question asked is how one would consider incorporating the recent findings from the IDEA study into the utilization of adjuvant chemotherapy for patients with stage II colon cancer. The findings from this landmark study indicated that under certain circumstances, specifically those of patients w...
What is your approach to locally advanced pancreatic cancer that has not progressed after neoadjuvant chemotherapy +/- chemoradiation but remains unresectable?
NRG GI011 was recently activated across the NCTN and will test ablative radiotherapy in this setting. This is a pragmatic and potentially practice-changing trial. Consider activating it at your center. Here is a nice summary from the PI @Dr. First Lasthttps://www.youtube.com/watch?v=MNsS7pHqZIk.
In which patients will you consider the use of adjuvant pertuzumab for HER2 positive early stage breast cancer?
The benefit of adding pertuzumab to a trastuzumab-based regimen is quite small (0.9% at 3 years, 1.8% in those with involved LNs). This will not change my practice for most patients. Certainly for a patient with multiple involved nodes and ER- disease, the addition of pertuzumab will become a long d...
Do you recommend MSI testing to any tumor that is not already eligible for immunotherapy?
The accelerated approval of pembrolizumab in MSI-H tumors was based on data from 149 pateints with MSI-H or dMMR cancers from five different single arm studies. Ninety of those patients were colorectal, the remaining 59 were a mix of 14 different types. The ORR for the entire group was almost 40% wi...
What treatment would you offer for patients with metastatic NSCLC (adenocarcinoma) who are EGFR positive AND PD-L1 >50%, who fail first line EGFR therapy (and are negative for T790M mutation)?
There are many clinical trial approaches that are evaluating immunotherapy among patients with EGFR mutations. Yet, there is little data to date of large populations of patients with long lasting responses to single agent PD-1 or PD-L1 inhibitors in the setting of EGFR mutations. Outside of a clinic...
What is your strategy to help prevent paclitaxel-related neuropathy?
There are no proven strategies for prevention of CIPN and the use of these supplements is not recommended. Some supplements such as acetyl carnitine can actually worsen neuropathy outcomes and some supplements such as B12, vitamin C, and others may negatively interact with chemotherapy and worsen di...
What experience do you have with paralysis or myasthenia-like symptoms developing on temozolomide?
This is not an established toxicity of temozolomide and would warrant further investigation.
How does genomic profiling/next-generation sequencing assays influence your treatment recommendations in metastatic breast cancer?
At the current time, there are no evidence-based, FDA-approved or NCCN-recommended uses of genomic or protein-based assays other than ER, PR, or HER as well as gene expression profiling results like the 21-gene/Oncotype or 70-gene MammaPrint assay for routine management of breast cancer. There is no...