Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Would you offer adjuvant chemotherapy for a pT1c triple negative invasive papillary carcinoma of breast?
I would offer it if the node is positive. For node negative, I would determine it according to the potential risk of relapse and the benefits and risks of systemic therapy.
What volumes do you treat for ISRT for extranodal DLBCL?
It is important to remember that ISRT, for both Hodgkin and non-Hodgkin lymphoma, consists of a set of principles that can be used to design rational radiation fields in the context of modern treatment planning. In general, only sites of original involvement are treated when patients also receive, a...
When utilizing ISRT for Hodgkin lymphoma, what volumetric expansions (ITV and PTV) are appropriate on top of the CTV that includes the original pre-systemic therapy disease?
First, it is important to realize that involved-site radiation therapy (ISRT) for Hodgkin lymphoma is not a formulaic approach to field design. It requires careful evaluation of pre-chemotherapy imaging, fusing these with post-chemotherapy planning CT scans for optimal target delineation, evaluating...
What is your preferred first line therapy for metastatic sarcomatoid renal cell carcinoma?
Sarcomatoid RCC is a heterogeneous and difficult disease. Arising across all histologies, it generally portends a worse prognosis. VEGF TKIs have activity and I think are the default standard of care, but outcomes are suboptimal. Chemotherapy regimens have been tried with limited success, although I...
How would you proceed after complete response to carboplatin/paclitaxel/bevacizumab in a patient who presented with distantly recurrent SCC of the cervix?
I favor treating this patient in accordance with patients on GOG 240 where the patients were treated until disease progression, unacceptable toxicity, or complete response. In this pivotal prospective study, combination platinum doublets with bevacizumab were shown to have high response rates, compl...
Would you offer neoadjuvant pembrolizumab to a TNBC patient with multiple pulmonary nodules and bilateral hilar adenopathy secondary to asymptomatic sarcoidosis (biopsy proven)?
Given the potential benefits of the addition of pembrolizumab to neoadjuvant chemotherapy in clinical stage IIB-III TNBC, I would favor doing so [but not for clinical stage I or small IIA (T<3 cm N0), in whom the potential benefits would be more modest], but I would monitor the patient closely for a...
Would you use fezolinetant for hot flashes for men on ADT?
I might consider it after trying the usual agents that will at least partially relieve symptoms in the majority of patients, such as low-dose megestrol or venlafaxine (there are others, but these are the ones with which I have had the most experience and success). Fezolinetant is expensive and requi...
When do you consider the addition of concurrent pembrolizumab to breast irradiation?
With the publication of KEYNOTE-522 (Schmid et al., PMID 32101663), we are seeing this scenario much more frequently as patients continue the pembrolizumab in the adjuvant setting.A post-hoc analysis of the timing of radiation in the KEYNOTE-522 trial was presented in abstract form at SABCS 2022, (P...
How would you approach first-line treatment for a patient with metastatic colon cancer who develops an anaphylactic reaction to cetuximab with FOLFOX/cetuximab/encorafenib?
In the guidelines, the fully humanized version of panitumumab can be used interchangeably where cetuximab is indicated for patients with colorectal cancer.The anaphylactic reactions are not uncommon, going back to the homology with the tick bite story.Chung et al., PMID 18337601I have encountered pu...
Do you perform EBUS-TBNA for staging in patients with biopsy proven malignant lung nodules with no lymphadenopathy on CT chest and PET scan?
I agree that incidence is low, but estimates for radiographically occult nodal disease range from 10-20% and the fact is there isn't great literature on this. A PET scan is a decent test, better than a regular CT, but there are still a significant minority of patients that are mis-staged when an EBU...