Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
What are your top takeaways in GU Cancers from ASCO 2024?
PSMAfore presented previously showed (177Lu-PSMA-617) prolonged radiographic progression-free survival vs change of androgen receptor pathway inhibitor (ARPI) in taxane-naïve patients with metastatic castration-resistant prostate cancer. At ASCO, data presented showed 177Lu-PSMA-617 delayed time to ...
What is the appropriate timeline to start post mastectomy chest wall/regional nodal XRT (+/- reconstruction) after surgery?
If the patient received neoadjuvant chemotherapy, we typically give RT prior to additional chemotherapy (ex. xeloda for triple negative with residual, TDM1 for HER2+ with residual) and try to start 4-6 weeks post-op given that they are well healed and/or reconstruction/expanders completely filled. I...
In a patient with node-positive limited-stage small cell lung cancer, how do you approach radiation in a patient whose small primary tumor resolves after one cycle of chemotherapy?
In the case of imaging CR, I delineate CTVp based on pre-chemo volumes and apply PTV margin. If less than CR, I use post-chemo volumes to delineate GTVp and then utilize 4DCT to construct ITVp followed by appropriate CTV and PTV margins. Both approaches are consistent with ESTRO ACROP guidelines pub...
How would you approach a primary small cell carcinoma of the vagina in a patient with an intact uterus and cervix?
We treat with the same principle as cervical small cell with combination of concurrent chemo with cis and RT (EBRT plus brachy) followed by adjuvant cis and etoposide. No pCI.
How would you treat locally advanced melanoma of the scalp with several in transit lesions and a metastatic lesion to the parotid if the patient is progressing on immunotherapy such as pembrolizumab?
I think it is important to first define whether this is truly primary progression or whether the patient may have a delayed response. The Society for Immunotherapy of Cancer (SITC) has some consensus guidelines for defining this:Kluger et al., PMID 32238470 It is important to recognize that these ar...
How would you treat a patient with muscle invasive urothelial carcinoma with squamous differentiation?
In general, pure and predominant urothelial carcinoma (majority or >50% of tumor consisting of urothelial carcinoma) have been treated similarly at least in trials. Patients with predominant or pure non-urothelial histology have typically not been enrolled in trials of urothelial carcinoma. There ar...
What is the appropriate RT dose for an advanced stage follicular lymphoma?
Depends on the specific clinical scenario. However, in general, RT in advanced stage follicular lymphoma is palliative. Therefore, I would start 2Gyx2. Repeat as needed. If cord compression or something serious, would consider 24Gy.
How long would you wait after a cycle of IT MTX to treat a spinal lesion causing cord compression in a patient with stage IV DLBCL?
Intrathecal methotrexate has biphasic half-lives of about 5 hours and 14 hours (Bleyer, Cancer Treat Rep 1977). ILROG recommends typically waiting minimum interval 2 weeks between last IT or high-dose IV methotrexate before starting CNS radiotherapy for CNS leukemia, but urgent radiotherapy may be c...
Do you utilize tumor treating fields in patients with anaplastic pleomorphic xanthoastrocytoma (PXA) III?
I would, but I haven't actually had the opportunity. With more information appearing that TTF is effective in brain metastases, mesothelioma, and pancreatic cancer, why wouldn't you use it if you didn't have a better option? The only real risk is financial.
How would you approach surveillance imaging for men with early-stage, hormone receptor-positive breast cancer after unilateral mastectomy?
As always, appreciate others' input. If you're referring to systemic imaging, I do not obtain surveillance systemic imaging as part of surveillance for any patient with early-stage hormone-positive breast cancer (male or female) unless there are symptoms or initial labs that suggest possible metasta...