Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How would you approach the treatment of low grade, stage IA, triple negative apocrine adenocarcinoma of the breast in a female patient in her 70s?
I would not treat this the way I would a typical triple-negative breast cancer, since the risk of distant recurrence from occult metastatic disease is low. Assuming she had breast-conserving surgery, radiation, favoring partial breast, is reasonable. In terms of systemic therapy, if the cancer in th...
Do you consider estrogen patches in treatment of prostate cancer?
Oral estrogenic formulation (such as DES) was historically used for androgen suppression in prostate cancer patients. This was based on the principle that estrogen decreased serum testosterone levels by suppressing luteinizing hormone production through a negative feedback loop on the hypothalamus a...
Which patients, if any, do you offer transdermal estradiol as a method of ADT instead of LHRH agonists?
My default form of ADT remains a GnRH agonist or antagonist but estradiol transdermal patches are clearly effective and safe as an alternative option for men who either 1) have significant loss of bone density/osteoporosis, 2) have significant hot flashes with traditional ADT and wish to try an alte...
What initial systemic approach will you recommend for metastatic pMMR HER2-positive esophageal/GEJ/gastric adenocarcinoma with PDL1 of 0?
FOLFOX-trastuzumab-pembrolizumab is consistent with the 2023 Immunotherapy and Targeted Therapy for Advanced Gastroesophageal Cancer: ASCO Guideline (Shah et al., PMID 36603169). In KEYNOTE-811, a response benefit was shown by adding pembrolizumab to trastuzumab plus chemotherapy. In this trial, 13%...
Which GI cancer patients do you use oral contrast in staging CT scans?
We do not use oral contrast for most of our patients and only offer oral contrast CT scans for patients we are concerned about perforation.
What is your preferred third-line therapy for metastatic colon cancer, RAS-WT, MSS, low TMB, with no targetable alterations?
My preferred treatment in this scenario is trifluridine-tipiracil plus bevacizumab. This is based on the favorable side-effect profile of this regimen (compared to alternatives) and the evidence from the SUNLIGHT trial, which showed that bevacizumab plus trifluridine-tipiracil was superior to triflu...
In a patient with unresectable HCC who developed immune-related colitis with the first dose of tremelimumab/durvalumab, would you consider continuing durvalumab alone after resolution of the colitis with steroid treatment?
I haven’t seen too many TREMI/DURVA colitis cases, but basing experience off of BOT/BAL, which is notorious for the CTLA-4 inhibitor-related BOT-colitis, as well as some patients who have had IPI/NIVO colitis, or any grade ≥3 event in the combination setting, it’d be reasonable to continue the PD1/P...
Would you offer adjuvant therapy to a patient with a high-grade mucinous appendiceal neoplasm that is pT3 pN0 M0, >12 lymph nodes removed with ileocecectomy?
I would.
How long would you continue atezolizumab/bevacizumab in a patient with HCC who is having a prolonged response with stable disease?
Similar to how this was done in the phase 3 trial of atezolizumab/bevacizumab (vs sorafenib), I continue until progression or intolerance. Finn et al., PMID 32402160
How are you deciding between T-DXd/pertuzumab and THP> HP/tucatinib in patients with metastatic HER2+ breast cancer?
I am reserving HP/tucatinib to the maintenance setting (after 1L THP, as was studied in HER2CLIMB-05, but also will plan to offer it as maintenance after 1L T-DXd/P in patients who experience cumulative toxicity on T-DXd/P and need to stop). I would tend to offer HP/tucatinib maintenance to those wi...