Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How would you manage a patient with new FDG avid retroperitoneal lymph nodes after completing definitive chemoradiation for stage III anal canal cancer?
I agree with @Dr. First Last. PA nodes are not really systemic disease if you consider the disease biology. They are regional nodes. There is 100% RR and >90% LC with chemoradiation with very low risk.
Is there any data to support the combination of a CDK 4/6 inhibitor with tamoxifen?
The best data for this combination comes from MONALEESA-7, which combined tamoxifen or an AI (+ ovarian suppression in all patients) with ribociclib or placebo in premenopausal women with advanced HR+, HER2 negative breast cancer. This was presented at SABCS 2017. Tamoxifen treatment was selected in...
Would you ever consider foregoing surveillance CT scans for resected stage II or III colon cancer in favor of circulating ctDNA assays?
As someone who was introduced to CEA in colon surveillance when discovered simultaneously by Gold and LoGerfo in the early 1970s, I am excited by the rapid acceptance of ctDNA in evaluation and management of colon cancer. We know that ctDNA can be positive up to 9 months before a CT scan demonstrate...
Is it acceptable to give weekly cisplatin for patients with locally advanced head and neck SCC undergoing chemoradiation?
@Dr. First Last just presented at the ASCO H&N highlights session that weekly cisplatin 40mg/m2 is now considered a standard of care, at least in the post-op high risk setting based on data by Dr. Kiyota et al. showing superior outcomes, likely due to higher cumulative cisplatin dose (>200mg/m2) com...
How do you approach initial treatment for AL amyloidosis with excess plasmacytosis in the bone marrow, that has cardiac involvement and is not a transplant candidate?
This is the mirror image of an earlier question on theMednet, namely how we would approach MM treatment in someone who was incidentally diagnosed with AL amyloidosis:https://www.themednet.org/question/13482Here, it's how we would approach AL amyloidosis with someone well over 10% bone marrow plasma ...
What are your top takeaways in GI Cancers from ASCO 2024?
Here are my top 3 ESOPEC with a 29-month survival advantage for FLOT chemotherapy over Cross-type chemoradiation for esophageal adenocarcinoma. New standard of care - we need to get used to using FLOT. CheckMate 8HW set a standard of ipi/nivo in dMMR colorectal cancer, with immunotherapy being v...
How would you treat a patient with emergence of EGFR C797S mutation at the time of progression on osimertinib given for EGFR T790M mutation?
Although I don't have a personal experience, there are reports of adding 1st or 2nd gen EGFR TKI such as gefitinib or erlotinib to Osimertinib.J Thorac Oncol. 2017 Nov;12(11):1728-1732. doi: 10.1016/j.jtho.2017.08.006. Epub 2017 Aug 24.Combination Osimertinib and Gefitinib in C797S and T790M EGFR-Mu...
Which patients with localized esophageal adenocarcinoma, if any, would you offer nivolumab after lack of pCR to neoadjuvant FLOT?
I have not been in such a situation, yet, but I am sure will be soon! My thought will be to start off with patients with a PDL1 score of at least 5. Not sure the degree of path response can predict immune therapy sensitivity, so at this time, I would treat all except the pCR but may also consider li...
What dose and fields would you use to treat a low grade CNS lymphoma that presents as an isolated single mass in the brain?
De novo presentations of low-grade lymphomas in the brain parenchyma are very, very rare. Suppose a patient had a relatively small, well-localized, low-grade NHL such as FL or MZL in the brain parenchyma, without any evidence of disease elsewhere (negative PET-CT, bone marrow biopsy, etc.). In that ...
When and how do we do cytoreduction in CLL?
Cytoreduction is almost never needed in CLL just for the sake of lowering the number. Rare case reports exist of leukostasis with WBC counts over 700k, but these are exceptions. If there are leukostasis symptoms with lower WBC counts then the diagnosis of CLL should be questioned. Having said that, ...