Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
What treatment regimen would you recommend for young adults with platinum refractory relapsed germ cell tumors?
We assess the patient risk by IPFSG score, and if it is high score or has extragonadal primary site then we consider tandem high dose chemotherapy and autologous transplantation https://onlinelibrary.wiley.com/doi/full/10.1002/acg2.47 The data sometimes is unclear on the role of HDCT . - the larges...
What adjuvant therapy, if any, is best for mucinous tubular and spindle cell carcinoma of the kidney?
Mucinous tubular and spindle cell carcinoma (MTSCCC) of kidneys is a rare RCC variant which was first described in WHO 2024 updates of the classification of RCC (Moch et al., PMID 35853783). Most cases are diagnosed incidentally and typically have an indolent course with good long-term prognosis (Ku...
What neoadjuvant regimen would you give a patient with multicentric IDC consisting of TNBC and concurrent ER/PR- HER2+ breast cancer with ER/PR- HER2+ axillary LN mets?
In cases where we had heterogenous multicentric TNBC and HER2+ disease and the patient had no major cardiac risk factors, we tended to use more AC-THP vs. TCHP in those cases. The addition of the anthracycline to the taxane was felt to be appropriate to better cover both types of cancers (although c...
Would you offer consolidative full dose chemo-RT for local residual pancreatic disease in a patient with stage IV pancreatic adenocarcinoma with excellent response after induction chemotherapy?
I think radiotherapy can selectively be considered in patients like this. The potential roles of radiation therapy could include: Palliation of local symptoms. RT is very effective at palliating symptoms such as pain related to celiac plexus infiltration, etc. Lawrence et al., Journal of Clinical O...
What are your top takeaways in Head & Neck Cancers from ASCO 2024?
The PATHWay study Abstract 6008: checkpoint inhibitor therapy has become instrumental in the treatment of recurrent and metastatic head and neck squamous cell carcinomas. However, we still do not have data to inform us whether treatment with such agents is beneficial in the adjuvant setting. In thi...
When giving concurrent chemoradiation therapy, is it important that the infusion be prior to RT as opposed to after RT?
Radiobiological data suggest better cell kill when cisplatin is given before RT and then given after (1.7x vs. 1.2x) and similarly when delivered daily vs when delivered weekly. In practice, for that reason, we do it before RT and early in the week (Monday or Tuesday). The ongoing cervix OUTBACK tri...
For a completely resected high risk adrenal cortical carcinoma with a high mitotic rate, what is your approach to adjuvant therapy?
I do not ROUTINELY use adjuvant therapy for completely resected adrenal carcinoma. I think that the quality of surgery is more important, and generally am more comfortable if this has been undertaken by an experienced urologist or endocrine cancer surgeon who has achieved R0 status (full pathologica...
How are you approaching patients who receive neoadjuvant chemo immunotherapy for resectable NSCLC who after completion of neoadjuvant treatment are no longer surgical candidates due to factors such as toxicity, decline in PS, or patient preference?
This scenario seems to happen in 17-20% of patients. It’s very important to appropriately stage patients at diagnosis with PET CT, EBUS, etc to ensure accurate staging without which a good discussion regarding resectability is not possible. If a patient does, in spite of our due diligence, end up no...
What impacts your decisions regarding the use of immunotherapy in metastatic G/E/GEJ cancers overall in light of variations in FDA approval, guidelines, and trial data?
The decision really lies in balancing the likelihood of benefit against potential toxicity. Checkpoint inhibition is generally very well tolerated, but there are patients that I am hesitant to consider it, including patients with rheumatoid arthritis, inflammatory bowel disease, or other autoimmune ...
How is transferrin saturation a reliable indicator for any parameter if serum iron is not reliable?
The question is a very good question. The Fe/TIBC must be drawn on an overnight fast including any vitamin pills containing iron. Otherwise, the serum iron is speciously elevated which in turn speciously elevates the TSAT. If those conditions are met, the TSAT is as good as the transferrin receptor ...