Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How do you approach the treatment of de novo, brain-only metastatic HER2 positive breast cancer?
Patients who present with de novo, brain-only metastases of HER2+ breast cancer are rare, and hence, there is no good clinical experience or clinical trial basis upon which to base clinical practice recommendations. The current ASCO guidelines for the management of HER2+ brain metastases call for ap...
How do you counsel patients about prognosis with FIGO 2018 IIIC cervix cancer managed in the new era of chemoradiation plus immunotherapy?
The prognosis is still a function of nodal location, number of nodes, local T stage, histology, and response to the EBRT portion of treatment. The local control is closer to 90% with a predominant pattern of failure being distant (around 20-25%). Also based on A-18, 3 years PFS is around 70% and OS ...
Is there any circumstance where you would consider bevacizumab in patients with locally advanced colorectal cancer with rectouterine fistula?
I would not. In my mind, a fistula is an absolute contraindication for VEGF inhibitors of all varieties.
Would you use T-DXd or capecitabine/trastuzumab/tucatinib for HER2+ metastatic breast cancer with predominantly CNS progression after THP?
We now have long-term overall survival data from the DESTINY-Breast03 (DB03) trial, which further supports the efficacy of trastuzumab deruxtecan (T-DXd) in patients with HER2+ metastatic breast cancer, including those with CNS metastases. However, my preference remains unchanged, favoring the HER2C...
How would you manage new symptomatic brain metastases (10-15) in a young woman with HER2+ metastatic breast cancer?
A lot of nuance to answering this on a per-patient basis.First question, how symptomatic? (As in, are there bulky mets that we should be considering surgical management upfront plus this also guides my discussion about whole brain vs systemic)If not acutely symptomatic and requiring a crani/resectio...
Would you offer neoadjuvant chemotherapy to premenopausal women with cT1cN0 HER2+ breast cancer?
Since most neo-adjuvant trials required that primary tumor was at least 2 cm, I tend to lean towards upfront surgery. If the tumor size is confirmed and sentinel lymph nodes are negative, the patient could be offered paclitaxel and trastuzumab which is significantly less toxic than pertuzumab in com...
Do you utilize MammaPrint testing to determine whether or not to offer neoadjuvant chemotherapy for high-risk ER+ breast cancer?
Yes, MammaPrint is a genomic test that can be used to identify ER+ patients who benefit from adjuvant chemotherapy. If a patient is predicted to benefit from adjuvant chemotherapy, she will also benefit to the same extent if she receives the treatment preoperatively.Preoperative administration may b...
How would you treat pelvic node recurrence after prior RP and adjuvant XRT prostate bed only?
RT to pelvic nodes to aortic bifurcation, boost positive nodes, plus ADT.
How would you approach treatment for patients with limited stage small cell lung cancer who, after initial carboplatin/etoposide, develop a new contralateral lung nodule confirmed as SCLC, while their primary tumor shows a partial response?
I assume the scenario is a newly diagnosed LS SCLC in a patient who was appropriately staged with PETCT, brain MRI, etc at time of initial diagnosis. Patient is then treated with definitive chemorads with 4 cycles of platinum/etoposide and xrt. At the time of re staging PETCT, a new contralateral no...
Would you still offer adjuvant chemo at 24 weeks post Whipple for a pT1c pN2 cM0 neg margins ampullary adenocarcinoma?
No, I would not.