Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Do you offer prostate RT to men with 0-3 bone metastases on conventional imaging when PSMA PET shows a very high number of M1 lesions?
This would be a hard no from my standpoint.I get the rationale here. STAMPEDE found a survival benefit for prostate-directed RT in men with "low volume" disease, which was defined based on the CHAARTED trial with conventional imaging. Therefore, men with low-volume disease on conventional imaging fi...
How do you approach conversations regarding discontinuation of transfusions in patients with advanced hematologic malignancies who are otherwise appropriate for hospice?
While not an expert in leukemia care or MDS, the answer is nuanced (both in the care of patients and to hospice agencies). Some hospice programs will make exceptions to blood transfusions depending on how frequent - so it is always good to ask. From a clinical perspective, important to consider whet...
How do you approach conversations regarding discontinuation of transfusions in patients with advanced hematologic malignancies who are otherwise appropriate for hospice?
While not an expert in leukemia care or MDS, the answer is nuanced (both in the care of patients and to hospice agencies). Some hospice programs will make exceptions to blood transfusions depending on how frequent - so it is always good to ask. From a clinical perspective, important to consider whet...
What would you recommend for a stage I diffuse large B cell lymphoma (IPI 0-1) involving a single lymph node that is completely removed with an excisional biopsy?
Some more info woud be helpful such as age of pt, size and location of node, margins of resection. In general 6 cycles of RCHOP is prefered with RT in almost all instances. 3 cycles is reserved for the most favorable patients. I would add ISRT adhering to recent guidelines from Intl Lymphoma Radiati...
Is it appropriate to re-consider bladder preservation in patients with bladder muscle-invasive cancer (T2) who were initially poor candidates for BP (multifocal disease, etc.) but had complete response after neoadjuvant chemotherapy?
It is perfectly appropriate. There are many ways to achieve a complete response to T2 bladder cancer. It can be reached with radiation, an aggressive local resection, or chemotherapy. The issue is whether or not it is durable. None of these therapies alone have a great track record, although chemoth...
What is your surveillance approach for outpatient monitoring of ICI myocarditis?
Screening and surveillance strategies for outpatient monitoring of ICI myocarditis are not well-defined. The best surveillance approach would be based on clinical risk assessment, followed by biomarker and imaging data. The risk factors for ICI myocarditis remain to be clarified, but the most valida...
For patients with large, partially or nearly obstructing rectal cancers, how do you sequence TNT in order to avoid complete obstruction and surgical diversion?
I personally favor starting with RT/chemo, but starting with chemo can work well. The more important issue is the side questions. First, there is a huge difference between a lesion that is large and one that is nearly completely obstructing. Unfortunately, many endoscopists use the term "obstructing...
Would you consider proton therapy as part of TNT for rectal cancer?
Show me the data. Our results with conventional 3D XRT are excellent with a low rate of chronic toxicities and even lower rates of pelvic recurrences.
Would you offer inguinal nodal RT to a patient with anal SCC (pT1N1a, + inguinal node) following APR in the setting of prior prostate + pelvic nodal radiation?
Inguinal lymph node dissection is not typically part of APR procedures. Even when surgical dissection of the inguinal lymph nodes is performed, the recurrence or failure rates in this region can still be significant, with some studies reporting failure rates of around 10-15% despite extensive surger...
Do you still offer adjuvant chemotherapy and chemoradiation for NSCLC after neoadjuvant chemoimmunotherapy?
In the pre-neoadjuvant era, the options for patients who had R1 (positive margin) or R2 (gross residual disease) were: re-resection followed by adjuvant chemo; sequential adjuvant chemo followed by radiation; or concurrent chemoradiation. There is retrospective data suggesting a survival benefit fro...