Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How do you treat a female with a diagnosis of invasive apocrine carcinoma of the breast?
While some data suggests that apocrine cancers may not respond as well to chemotherapy as ‘usual’ triple negative breast cancers, 80-90% are basal-like by gene expression analysis. I treat them the same way - with adjuvant chemotherapy for Stage I cancers (or Stage II-III patients who didn’t receive...
How do you approach patients with osteosarcoma of the maxilla for neoadjuvant chemotherapy?
The SOC treatment for “jaw” OS is a margin negative surgical resection. If indeed feasible (not always the case), this applies to maxillary tumors. Jaw OS does respond poorly to standard chemotherapy. In our experience, HD Ifosfamide may be a better choice than standard Dox/CDDP. We use this approac...
How would you approach the treatment of checkpoint-inhibitor-mediated temporal arteritis?
Temporal arteritis or GCA is a rare immune related adverse event due to immune checkpoint inhibitor (ICI) therapy. Corticosteroids are the first line treatment, along with holding the ICI. As there have been limited cases, there is not evidence for IVIG in this setting.
For a very high risk prostate cancer with relatively no elevation in PSA but no distant or nodal metastasis would you consider “neoadjuvant” ADT and chemotherapy prior to EBRT?
This is a very challenging scenario in dealing with men who have M0 N0 but very high risk disease with a Gleason 10 (grade group 5) locally advanced tumor. Recent data supports a very poor outcome for these low PSA high grade patients when treated with IMRT and ADT alone (Mahal BA et al Eur Urol 201...
What endocrine therapy would you recommend to a premenopausal female with early stage HR+ Breast cancer who is transitioning from female to male and currently on testosterone?
There is not a lot of data, and so shared decision-making is paramount, with the following considerations: Acknowledging the limited data in this setting, how would this patient feel about stopping testosterone? While many patients feel that T is critical for identity, others may not feel that way. ...
What is the best radiation dose to treat primary cutaneous B cell lymphoma?
For a small (1-2cm lesion) of these subtypes, 30Gy is usually adequate. For larger/thicker lesions, consider 36Gy. Electrons with bolus or orthovoltage/superficial therapy.
What is the role of "adjuvant" systemic chemotherapy in patients previously resected NSCLC, now with isolated solitary relapsed brain lesion, treated with resection and SBRT?
Most of the data/publications for treating isolated, solitary lesions (brain or otherwise) revolve around the local therapy (stereotactic radiosurgery or conventional surgery for example), and there is not much data regarding the use of systemic therapy in this setting. There is a recent article sug...
How would you manage a patient with antiphospholipid syndrome in the setting of severe steroid-refractory thrombocytopenia?
Dr. @Dr. First Last answered the question of severe thrombocytopenia in a patient with APS and an acute thrombotic stroke. I agree with his approach. However, this “between a rock and a hard place” clinical scenario does also appear not infrequently during the chronic management of patients with APS...
What is the best dose to treat splenomegaly with pancytonenia in the setting of myelofibrosis?
I have treated occassionally and have recommended 20 cGy to 25 cGy alternate day x 3 or 4 fractions It works well as spleen is a very radiosensitive organ and does not require doses above 150 cGy
What adjuvant therapy would you give to a patient with resected pT4bN2M0 MSI-H colon cancer and post-op markedly elevated CEA but no metastatic disease seen on imaging?
This patient has a high-risk stage III MSI-H colon cancer with persistently elevated CEA without radiographic evidence of disease (given the persistent elevated CEA after surgery, I would get a PET-CT to rule out occult metastatic lesion). The standard answer should be oxaliplatin-based systemic adj...