Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
What is your re-immunization strategy after auto SCT for patients with myeloma on dara/len maintenance?
We do the same vaccination sequence according to BMT/CTN, whether they are on maintenance dara or not. Here is our schedule Post autologous SCT vaccine Interval Date Vaccine Yearly Flu Vaccine 3-month post-transplant Pneumovax 20, Hib, hep A/hep B, polio, TDap, Shingrix 6 months post-transplant Pneu...
What is your re-immunization strategy after auto SCT for patients with myeloma on dara/len maintenance?
We do the same vaccination sequence according to BMT/CTN, whether they are on maintenance dara or not. Here is our schedule Post autologous SCT vaccine Interval Date Vaccine Yearly Flu Vaccine 3-month post-transplant Pneumovax 20, Hib, hep A/hep B, polio, TDap, Shingrix 6 months post-transplant Pneu...
Is it ever appropriate to omit temozolomide in unmethylated glioblastoma?
Perhaps a different perspective on this question would be which unmethylated patients would you be willing to not treat with up-front temozolomide? The genesis of the question and conundrum comes from the modest benefit described in the above-mentioned trials for this subgroup. As Hegi herself descr...
In patients with nasopharyngeal SCC that have an excellent response to induction chemo, do you alter your chemo-RT dose/volumes in any way?
I agree with Dr. @Dr. First Last. I do not change my volumes based on response to induction chemotherapy. It may be difficult to outline the nodal volume if there is complete response to chemo but I have not really encountered that scenario so far. I use the initial PET and diagnostic CT scans fused...
In patients with unresectable, liver-limited neuroendocrine tumors (NETs), what clinical or radiographic criteria guide your decision to prioritize systemic therapy over locoregional approaches?
The first question is always if it is truly unresectable... What is considered unresectable by some might be considered resectable by others, so I always recommend getting an opinion from an HPB surgeon with substantial experience in treating patients with NETs (whether that is done in person or at ...
How do you manage oxaliplatin-induced splenomegaly?
Oxaliplatin can lead to sinusoidal obstructive syndrome (SOS), which will result in portal hypertension. Splenomegaly is one of the portal hypertension signs.The SOS is correlated with cumulative oxaliplatin dose, and cumulative dose >1000 mg/m2 is considered a potential threshold (Overman et al., P...
What are your top takeaways from ASCO GI 2025?
1. BREAKWATER: Analysis of first-line encorafenib + cetuximab + chemotherapy in BRAF V600E-mutant metastatic colorectal cancer. This ambitious phase 3 randomized trial is an initiative of project frontrunner to attempt to allow access of targeted therapy in earlier lines of treatment for advanced ca...
In a patient with metastatic colorectal cancer to the lung and liver, is there a role for liver directed therapy if the lung is not amenable to local therapy?
This is a heterogeneous group of patients, so I don’t think there is one answer applicable to all clinical situations. This is why it is so important that these patients be discussed in a multidisciplinary setting. I’m assuming that in this situation the patient has had adequate systemic therapy to ...
Would you offer postoperative RT for pT2pN0 rectal cancer with close distal margin (within 2 mm) and only 6 lymph nodes obtained from surgery?
I assume the question is about the addition of chemoradiation in this setting. In this case, there is one clear reason to consider post op chemoradiation - the 6 LNs removed. This is clearly short of the standard for adequate lymphadenectomy of 12. It may be possible to ask the pathologist to review...
Are there any molecular predictors for response to chemoimmunotherapy for patients with ES-SCLC?
The short answer is no, there are no validated, clinically useful biomarkers to predict benefit (or lack of benefit) with immune checkpoint inhibitors for patients with SCLC.Early studies, including KEYNOTE-028 and KEYNOTE-158, suggested that PD-L1 TPS (tumor proportional score) correlated with resp...