Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
What are your top takeaways from ASCO GI 2026?
GLP1 agonist use is associated with improved outcomes for colorectal cancer in a retrospective United States study. Now we need to incorporate this into randomized trials. I think this also provides more evidence that metabolic syndrome type issues may help explain early-onset colorectal cancers. W...
Should all patients diagnosed with B12 deficiency get a baseline EGD?
It is important to determine the cause of B12 deficiency. The majority of cases are due to pernicious anemia (atrophic gastritis and lack of intrinsic factor), I presume this question relates to that group. If there is another cause such as intestinal malabsorption or bacterial overgrowth, this does...
How have you incorporated ctDNA into the clinical management of patients with gynecologic cancers?
ctDNA certainly is increasing rapidly in oncology and has been led by several other disease sites. I think right now, GYN oncology is figuring out how to incorporate this in our care to meaningfully impact our patients. I have not incorporated ctDNA in my practice routinely, but do see the role of i...
How do you prioritize treatment in a lung cancer patient who has HER2 IHC3+ along with other actionable mutations that have tumor-specific drugs available?
Non-small cell lung cancer (NSCLC) can harbor different HER2 alterations: HER2 protein overexpression (2-35%), HER2 gene amplification (2-20%), and HER2 gene mutations (1-4%). Unlike breast or gastric cancer, HER2 protein overexpression in NSCLC is not a validated biomarker for first-line HER2-targe...
How do you decide whether to use pharmacologic VTE prophylaxis in hospitalized patients with decompensated cirrhosis?
For all patients, I begin by using a standard risk prediction tool to determine if the patient is appropriate for pharmacologic VTE prophylaxis. At our institution, the Padua risk prediction tool is embedded in our electronic health record/admission set. Clinical guidelines- including those from the...
How do you sequence antiviral therapy and cancer-directed therapy in a newly diagnosed patient with hepatocellular carcinoma and incidentally found hepatitis C?
According to the recent publication by Cabibbo G, et at, J. Hepatol. 2019, 71, 265–273, yes direct-acting antivirals after successful treatment of early hepatocellular carcinoma improves survival in HCV-cirrhotic patients. No such data or evidence for advanced disease though. in that case, antiviral...
How would you approach a patient with Stage III gastric cancer and poor performance status who had large residual disease (ypT4N1) after neoadjuvant capecitabine and was later found to be MSI-H?
We are flying in the "no data" zone here. The MATTERHORN study, led by Dr. Janjigian et al., is a global 948-patient study in which patients with resectable gastric/GEJ adenocarcinoma received perioperative FLOT +/- perioperative (neoadjuvant/adjuvant) durvalumab. The press release on 6/2/23 showed ...
Would you offer chemotherapy to an elderly patient with MSI-H stage 3 colon cancer who cannot tolerate oxaliplatin?
The current NCCN guidelines already incorporated the ATOMIC study data and added CAPOX or FOLFOX with atezolimumab in addition to CAPOX or FOLFOX as preferred regimens for resected dMMR stage III colon cancer, while still listing single-agent fluoropyrimidine as an option.The interesting part to me ...
Do you check LDH levels for patients with CLL who are asymptomatic and on surveillance?
I personally include LDH as part of my routine chemistry panel monitoring of CLL in surveillance for several reasons. Often, patients with CLL can show up with new anemia; in such cases, the differential diagnosis is autoimmune hemolytic anemia versus disease progression. An elevated, new LDH level ...
Do you check LDH levels for patients with CLL who are asymptomatic and on surveillance?
I personally include LDH as part of my routine chemistry panel monitoring of CLL in surveillance for several reasons. Often, patients with CLL can show up with new anemia; in such cases, the differential diagnosis is autoimmune hemolytic anemia versus disease progression. An elevated, new LDH level ...