Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
What is your approach to patients with muscle-invasive bladder cancer who are ineligible for neoadjuvant cisplatin-based chemotherapy?
The data supporting the use of neoadjuvant chemotherapy for bladder cancer is derived from 2 randomized trials and a meta-analysis. The randomized trials demonstrating benefit used MVAC and CMV, respectively, both cisplatin-based combinations. The meta-analysis results support the use of neoadjuvant...
Do you offer adjuvant radiation therapy for a breast cancer patient with dermatomyositis?
This is an exceptionally important question for clinicians. I'm a little biased as I run an autoimmune Myositis Clinic, but here are my two cents: Paraneoplastic dermatomyositis (DM) is a fairly common occurrence (roughly about 15% of all DM cases, but up to 30-40% in some subtypes, such as adult pa...
Should patients with muscle invasive node negative bladder cancer wishing to have bladder preservation receive chemoRT alone or neoadjuvant chemotherapy followed by chemoRT?
The best evidence that we have does not support neoadjuvant chemotherapy before chemo-RT for bladder cancer. One RTOG trial, admittedly underpowered, and the MRC meta-analysis suggest that, while that benefit may exist for cystectomy, it either doesn't exist or is simply too small to detect for chem...
What role, if any, do biomarkers play in selecting appropriate patients for neoadjuvant cemiplimab in cutaneous squamous cell carcinoma?
Cutaneous squamous cell carcinoma (CSCC) is primarily a UV radiation driven malignancy and harbors many mutations. These cancers generally respond very favorably to PD-1 pathway inhibition, and thus biomarkers do not currently play a role in patient selection for neoadjuvant cemiplimab in CSCC. In t...
How would you treat locoregionally recurrent anal CA?
Surgical resection is standard of care for isolated locoregionally recurrent anal cancer - if the disease is resectable. Resectable disease includes local recurrence in the anal canal and limited nodal disease (i.e. mesorectal, possibly inguinal). Fixed pelvic side wall recurrence (nodal or direct e...
How do you approach evaluation and management of arthralgia in a patient after CAR-T cell therapy?
This is a great question - part of cytokine release at syndrome includes joint pain. So my questions are: How far after? What was the reason for the CAR-T? These are vital questions to understand first. To that be said - the answers will determine if you give a one-and-done treatment or long-term....
How do you approach evaluation and management of arthralgia in a patient after CAR-T cell therapy?
This is a great question - part of cytokine release at syndrome includes joint pain. So my questions are: How far after? What was the reason for the CAR-T? These are vital questions to understand first. To that be said - the answers will determine if you give a one-and-done treatment or long-term....
What is your approach to working up diarrhea in an immunocompromised patient?
Tough question and very common in clinical and research management. The approach is going to mirror any new complaint and start with a history. Diarrhea means many things to many patients/clinical trial subjects, so characterizing duration, frequency in a day, nocturnal events (diarrhea that occurs ...
How are you approaching patients with early-stage NSCLC who progress on neoadjuvant chemo-immunotherapy and are no longer surgical candidates?
This is a good question, and we are seeing it too often these days. This question cites progression as the reason for not proceeding to surgery after neoadjuvant chemo-IO. We are also seeing patient refusal and ineligibility (i.e. N3 disease that didn't respond) as reasons. I think it's very importa...
How would manage a patient with primary mediastinal NSGCT who has radiographic response but rising AFP while receiving VIP?
Patients with PMNSGCT are poor risk disease regardless of the size of the primary or amplitude of tumor markers hCG and AFP. For patients getting any cisplatin combination chemo, including testis primary, we always check tumor markers on day 1 of each course. In the patient in question, a rising mar...