Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Would you recommend adjuvant capecitabine and radiation in addition to adjuvant FOLFOX for a patient with resected pT3N2 rectosigmoid adenocarcinoma with other high-risk pathologic features?
As with all rectal tumors, those that are labeled as "rectosigmoid" should be reviewed in a multidisciplinary tumor board at a center with deep sub-specialty expertise. In general, radiation is provided for rectal cancers--unlike for colon cancers--because of the increased risk of local recurrence a...
In light of data from PRODIGE7, for patients with peritoneal metastasis from colon cancer, do you still offer HIPEC?
I think the PRODIGE 7 trial, while “negative” for the addition of HIPEC to cytoreduction, was an important trial in highlighting a potentially useful treatment approach for metastatic colorectal cancer with peritoneal only disease. The median survivals are encouraging for patients who receive initia...
How do you decide between HSCT and immunosuppressive therapy for treating hepatitis associated aplastic anemia?
For young people with a donor, the primary therapy is transplantation. It is curative in the vast majority of patients, hepatitis-associated AA is much less likely to respond to immunotherapy.
Can you/do you use an androgen receptor blocker alone in patients with metastatic hormone-sensitive prostate cancer who cannot tolerate GnRH-directed therapy?
Anti-androgen monotherapy for hormone-sensitive (M0 or M1) prostate cancer is not currently supported by FDA approvals or NCCN/AUA guidelines. Two recent studies that have explored enzalutamide monotherapy in patients with M0 and/or M1 hormone-sensitive prostate cancer are shown below. Enzalutamide ...
Would you offer adjuvant immunotherapy (pembrolizumab) for chromophobe RCC with R1 resection?
I have not experienced this situation yet in my own clinical practice but I would not offer adjuvant IO nor adjuvant radiation therapy for this patient. IO therapy has limited efficacy in this histology. This was shown best in the KEYNOTE-427 (monotherapy pembrolizumab in metastatic nccRCC, McDermo...
After completing SRS for brain mets, how long should the medical oncologist wait before starting chemotherapy?
I usually don't ask the medical oncologist to wait to deliver chemotherapy after SRS for brain mets. When delivering whole brain radiotherapy, there is some breakdown of the "blood-brain barrier" and this may account for the increased toxicity we see when chemotherapy is delivered during whole brain...
For HRRm prostate cancer, will you use olaparib alone or in combination with abiraterone?
The combination of a PARP inhibitor with a next-generation hormonal agent, including the combination of olaparib with abiraterone acetate, is not an FDA-approved combination and I do not recommend using it at this time. Both PROpel and MAGNITUDE showed a PFS benefit for the combination versus abirat...
When would you use PARP inhibitors in patients with refractory metastatic castrate resistant prostate cancer with somatic non-BRCA HRD mutations?
This is a very relevant question as clearly there is major heterogeneity in the outcomes with both olaparib and rucaparib in men with mCRPC based on their underlying germline or somatic tumor genomics. In addition, prior therapy and available alternatives including clinical trials with more or less ...
What is your general approach to treatment sequencing of available regimens in castration-resistant metastatic prostate cancer?
For mCRPC, my general approach with standard agents is a next-generation AR agent (typically started in the CSPC setting), followed by docetaxel, followed by Lu-PSMA. If disease is progressing slowly and is PSA producing, I will consider a switch from a first-line to a second-line hormonal agent, ty...
What is the role of adrenalectomy in managing isolated recurrence of stage IIIc melanoma, occurring 2 years after the original diagnosis, in a patient who declined adjuvant therapy?
Is the adrenal gland the only site of recurrence? Also, is the recurrence unilateral or bilateral? Unilateral adrenalectomy will not lead to permanent adrenal insufficiency, but bilateral adrenalectomy will (the patient will end up needing maintenance steroids permanently and need to have an endocri...