Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Are Mammaprint and OncotypeDx as useful in stratifying risk in patients with early stage HR+, HER2 negative lobular carcinomas, as in those with ductal carcinomas?
OncotypDX is not very useful in stratifying patients with early stage HR+ HER 2 negative invasive lobular carcinoma. Several studies (MD Anderson, Penn State) have shown that only 1-2 % of invasive ILC cancers are classified as High risk therefore receiving strong recommendation for chemotherapy. Si...
In early-stage ER‑positive, HER2‑negative breast cancer with germline BRCA1 mutation and high genomic risk, how should the choice between neoadjuvant and adjuvant chemotherapy be approached?
I typically do not use the BRCA1 mutation as the determining factor for a neo-adjuvant or adjuvant chemotherapy approach in patients with hormone receptor-positive, HER2-negative non-metastatic breast cancer. However, if the patient's characteristics and their disease would fit the eligibility crite...
How do you decide between blinatumomab or traditional chemotherapy in combination with TKI for upfront treatment of adult patients with Ph + ALL?
This question is likely inspired by the recent publication of a "chemotherapy-free induction and consolidation first-line treatment" for adults with Ph+ ALL (Foà et al., PMID 33085860; GIMEMA LAL2116). The authors reported relatively high rates of MRD- remissions by bone marrow BCR-ABL1 RT-PCR and i...
How do you decide between blinatumomab or traditional chemotherapy in combination with TKI for upfront treatment of adult patients with Ph + ALL?
This question is likely inspired by the recent publication of a "chemotherapy-free induction and consolidation first-line treatment" for adults with Ph+ ALL (Foà et al., PMID 33085860; GIMEMA LAL2116). The authors reported relatively high rates of MRD- remissions by bone marrow BCR-ABL1 RT-PCR and i...
In patients with newly diagnosed HER2+ early breast cancer, what do you anticipate will become the standard sequencing for T-DXd, neoadjuvant (DB11) or adjuvant (DB05) treatment?
Trastuzumab deruxtecan (T-DXd) is currently recommended in the adjuvant setting for patients with residual invasive disease after neoadjuvant therapy, based on the DESTINY-Breast05 trial, while its use in the neoadjuvant setting remains investigational. Ongoing neoadjuvant trials are evaluating T-DX...
When testing for patients with symptoms of MPN, do you prefer to do JAK2 cascade testing or a leukemia NGS testing panel?
Genetic testing with regard to the MPN can be usefully employed both diagnostically and prognostically. With respect to diagnosis, if an MPN is suspected based on symptoms such as aquagenic pruritis, ocular migraine, erythromelalgia, or the occurrence of an unexplained thrombosis, the first laborato...
When testing for patients with symptoms of MPN, do you prefer to do JAK2 cascade testing or a leukemia NGS testing panel?
Genetic testing with regard to the MPN can be usefully employed both diagnostically and prognostically. With respect to diagnosis, if an MPN is suspected based on symptoms such as aquagenic pruritis, ocular migraine, erythromelalgia, or the occurrence of an unexplained thrombosis, the first laborato...
What is your preferred treatment for non-contiguous Stage IIA Nodular Lymphocyte Predominant Hodgkin's Lymphoma (NLPHL)?
Prognosis of patients with early stage NLP-HL is excellent with any treatment, and multi-institutional studies have shown 5-year survival rates of 98% (Michael S. et al. Stage I-II nodular lymphocyte-predominant Hodgkin lymphoma: a multi-institutional study of adult patients by ILROG. Blood 2020; 13...
In a patient with unresectable, multifocal recurrent cutaneous squamous cell carcinoma and underlying T-cell large granular lymphocytic leukemia with baseline moderate pancytopenia, is anti-PD-1 therapy (e.g., cemiplimab) an appropriate and safe treatment option?
This is a complicated question! First, be sure of the diagnosis. The differential diagnosis is quite long. If it is something else that may or may not influence your decision. Second, if we agree that the lesions are not resectable, might they be treated with radiation therapy? This will not give th...
Could patients with smIPI >1 and poor tolerability to R-CHOP be offered ISRT after 3 cycles of R-CHOP if interim PET showed 5-PS 1-3 response?
The revised NCCN guidelines largely reflect data from studies demonstrating excellent outcomes with four cycles of R-CHOP in patients with low-risk diffuse large B-cell lymphoma (DLBCL), including FLYER, LYSA/GOELAMS, SWOG S1001, and the most recent trial, LNH2009-1B. Although each of these trials e...