Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How would you approach a patient with early-stage orbital MALT lymphoma with high proliferative index?
High proliferative index is uncommon in MALT lymphoma, seen more often with high grade histologic variants. For localized disease, it would not influence my management recommendations. For orbital MALT lymphoma, 24 Gy in 2 Gy fractions to the orbit. Efforts to shield part of the orbit should be unde...
How would you approach a patient with early-stage orbital MALT lymphoma with high proliferative index?
High proliferative index is uncommon in MALT lymphoma, seen more often with high grade histologic variants. For localized disease, it would not influence my management recommendations. For orbital MALT lymphoma, 24 Gy in 2 Gy fractions to the orbit. Efforts to shield part of the orbit should be unde...
For patients with T1 bladder cancer who have severe obstructive uropathy/hydronephrosis, do you treat as high risk stage I disease with RC, or clinically upstage and manage as a more locally advanced disease (NAC+RC)?
Clinical staging of bladder cancers with cystoscopy and imaging is associated with significant upstaging at immediate surgery nearly 25% of the time. Hydronephrosis is typically viewed as a T3 disease barring some other clear-cut cause high in the ureter such as a stone. Therefore, I prefer to have ...
Is there any evidence that ivermectin suppresses the PSA level in prostate cancer?
Is this even the right question, though? ADT drops PSA very reliably and yet does not cure patients. Finasteride suppresses PSA, but we do not use it as a mainstay of cancer treatment. Even if ivermectin *did* suppress PSA, unless there is a meaningful oncologic benefit (*at least* reduced recurrenc...
Would you switch from carboplatin/etoposide to cisplatin/etoposide in an LS-SCLC patient who initially declines cisplatin but subsequently agrees to it?
I have never seen such a clinical situation before. My simple answer would be that I would keep the carboplatin and not switch to cisplatin. That being said, I think there is more and more data that carboplatin and etoposide are pretty much equivalent to cisplatin and etoposide in LS-SCLC. There are...
When do you consider testing for dihydropyrimidine dehydrogenase (DPD) for patients prior to treatment with 5-FU/capecitabine?
Happy to address this question! It is my practice to test for DPD deficiency in all patients who will receive a first treatment with a fluoropyrimidine agent (5-FU or capecitabine). My objective in doing this is to avoid infrequent but readily avoidable severe toxicities and deaths related to DPD de...
How do you approach EGFR mutated NSCLC with isolated progression in the chest who is planned for a course of radiation at least 3-4 weeks?
This is an interesting question without a clear answer. There are two competing risks associated with either decision. The risk of continuing osimertinib while radiating chest disease is clearly that of pneumonitis with the overlapping risks from radiation and osimeritinib. The risk of holding osime...
When utilizing KN-A18 protocol, how do you best address symptoms of colitis/cystitis?
I have now anecdotally heard of 2 patients not completing EBRT/Brachytherapy due to the combined AI colitis picture superimposed on a traditional chemoRT GI toxicity. While there were reasons for patients to not complete pre-ICI, those reasons were generally not because of GI toxicity. The main thin...
What factors influence your decision regarding whether to administer a dose-dense chemotherapy regimen in the adjuvant setting to patients with hormone-receptor postive disease?
Many of the studies included in the analyses treated ER+ cases that we would call lower risk using modern genomic testing with adjuvant chemotherapy. So the observed effect of chemotherapy on recurrence and OS in ER+ disease can vary from study to study, depending on the numbers of low vs high risk ...
Should women with adequately debulked ovarian cancer receive bevacizumab with chemotherapy in the adjuvant setting?
The answer to this question is definitively NO.Two large, definitive studies (ICON-7 and GOG218 – including over 3400 patient combined) evaluated the impact of adjuvant chemotherapy with concurrent + maintenance bevacizumab. Analysis of mature data from ICON-7 demonstrated a significant overall surv...