Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How has COVID-19 altered your recommendations for invasive mediastinal staging for NSCLC?
I just had this discussion with our chief of interventional pulmonolgy at MD Anderson. Some of his faculty are being asked to staff our COVID-19 patient floor. In addition, bronchoscopy procedures should be considered high-risk procedures, and are required to have at least 45 minutes in between proc...
In light of the pending overall survival data and reported declines in quality of life associated with the PSMAddition trial, how do you envision incorporating Pluvicto into the management of mHSPC?
The PSMAddition trial was a phase III trial of [177Lu]Lu-PSMA-617 (i.e., Pluvicto) combined with androgen deprivation therapy (ADT) plus an androgen receptor pathway inhibitor (ARPI) in patients with PSMA-positive metastatic hormone-sensitive prostate cancer (mHSPC). This trial randomized men with u...
When do you start adjuvant radiation with areas of delayed wound healing after reduction mammoplasty?
Great question. I have cared for many patients with delayed healing post-lumpectomy (e.g., from infection, wound failure, etc.), and that experience is likely pertinent to the mammoplasty setting. Once the wound is open, it is going to take many weeks/months to “fully” heal, and it is not practical...
Is there any data on the use of PARP inhibitors in patients with metastatic urothelial carcinoma with deleterious DDR mutations?
Urothelial cancers harbor high rate of deleterious DDR alterations. Based on clinical data from other tumor types, especially TOPARP-A in metastatic castration-resistant prostate cancer where responses to olaparib monotherapy were observed especially among men with defective DDR genes, the use of PA...
How would you treat a patient with metastatic NSCLC on pembrolizumab with a sustained complete response, now with 2 isolated small liver lesions?
I am unaware of any "level 1" evidence for this approach, much of our data is anecdotal, however there is certainly reasonable experience of treating "oligo-progressive" disease with local therapies. While there is more experience in adrenal and CNS metastatic disease, I would think that a local the...
How would you approach a stage 1 HR+/HER2- pre-menopausal patient <50 years old with Oncotype DX RS of 24?
All the prior comments are very reasonable. It is hard to completely exclude a small absolute benefit from chemotherapy in this group. The trial's subset analyses aren't designed to definitively answer whether ovarian suppression or direct action of the chemo led to the observed risk reduction in <5...
For patients with cT1-T3 cN0 cM0 mid/low rectal cancer seeking organ preservation, what treatment approach do you recommend?
This is an important question; however, the answer is unknown. The key outcome that should be the focal point for the best treatment option, is which treatment strategy results in the most optimal patient reported quality of life and bowel function. Currently, this remains void of prospective, rando...
How long do you treat with IMID in a case of smoldering multiple myeloma?
I have not yet adopted use of lenalidomide for SMM, as I believe in the future, we will do away with the definition of SMM—patients either have MGUS which is observed, versus MM which requires the standard platform of myeloma treatment. This will be accomplished with a better molecular understanding...
Would you offer radiation therapy for stage IV pancreatic adenocarcinoma with liver metastases after 12 cycles of FOLFIRINOX and maintenance capecitabine, now with locally progressive disease at the pancreatic primary and rising CA 19-9?
Although not stated in the question, I assume this is a situation in which the liver metastases appear to be responding to chemotherapy with a radiographic partial response or stable disease. If the patient were progressing in both the liver and the pancreas, the next step in management would most l...
How do you counsel patients on the risk of thromboembolic complications with use of immunotherapy in NSCLC?
Patients with metastatic lung cancer are at increased risk of thromboembolic events with an estimated frequency of 13.9% (Connolly et al., PMID 23026639). Preclinical data show that PD-1/PD-1 pathway blockade may lead to increased levels of pro-inflammatory cytokines and T cell driven progression an...