Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
In light of the recently published LAP07 trial, what is the role of radiation in unresectable pancreatic cancer?
The recent publication of LAP07 is welcome, as the results have been known since the data were presented at ASCO 2013, and my impression is that the results have already led to a reduction in the use of radiation for locally advanced pancreatic cancer. This may be appropriate, but the results need t...
Would you use elacestrant in a patient with an ESR1-AKAP12 fusion?
These ESR1 fusions usually replace the ligand binding domain (LBD) of the estrogen receptor alpha protein with a portion of another protein like AKAP12. The fusion protein can cause oncogenic signaling in those clones. Since SERDs and SERMs target the LBD of ESR1, the drugs are not expected to work ...
What CTV margins should be used with early stage favorable Hodgkin's Lymphoma in the illiac chain if they had a complete response on PET after 2 cycles of ABVD?
Involved site radiation therapy (ISRT) is currently the methodology of planning a course of RT for patients with lymphoma. It should be emphasized that ISRT is NOT synonymous with "small" radiation fields. It is a system whereby 3D anatomy is utilized (instead of bony landmarks) to delineate a GTV, ...
What systemic therapy would you recommend for metastatic pleomorphic dermal sarcoma with a large inoperable solitary lung metastasis that is too large for radiotherapy?
This a rare entity, typically originating in the scalp/head and neck location, more locally aggressive than an AFX (atypical fibroxanthoma), but generally not as bad as a UPS. Very rarely, it can behave like a UPS with distant metastatic disease. NOTCH 1/2, FAT 1 mutations, and various CNAs have bee...
Do you hold immunotherapy when administering lung SBRT?
Good question, limited data to inform an answer.An ongoing trial ("iSABR") in which we are participating involves giving durvalumab 5 days prior to lung SBRT for early stage NSCLC and then continuing that agent for a total of 5 cycles; data are maturing, so I can't offer an estimate of pneumonitis r...
How might you alter treatment for a breast cancer patient receiving standard taxane-based adjuvant therapy who develops an adverse reaction to the taxane (e.g. severe pneumonitis) after completion of ddAC?
The two questions to address in making a decision are how sure we are that the paclitaxel is responsible for the pneumonitis and how much we expect the taxane to contribute to reducing the patient's risk of recurrence.In regards the former, we know that many hypersensitivity reactions to standard (s...
What are your top takeaways in GI Cancers from ASCO 2023?
It was a big year for rectal cancer treatment! PROSPECT (Deb Schrag et al.,) - for selected “high” rectal cancers we can likely omit radiation if they have a good response to FOLFOX. Notable exceptions: tumors that require an APR, are stage T4 or N2. About 10% of patients will not have at least a 20...
Do you offer memantine for cognitive preservation to glioma patients?
I do not as there is currently no evidence to support this. There was a trial conducted by the RTOG for whole brain RT patients with mets which demonstrated a trend towards improvement in time to cognitive decline (53.8 % at 24 weeks for memantine vs 64.9 % for placebo), executive function at 8 and ...
Is dyspnea without radiation pneumonitis a side effect of lung radiation?
Thanks for the interesting question. I would want to know: on what basis are we saying that the patient does not have radiation pneumonitis (RP)? I am going to assume that this is being stated since the imaging findings are underwhelming in this case. Assuming that this is the case, I would answer: ...
Would you give immunotherapy to patient with metastatic NSCLC who had liver transplant for hepatocellular carcinoma and now is progressing on chemotherapy?
This highly challenging question addresses a very important general issue in the context of a unique patient case. How far can we push the boundaries of using checkpoint inhibitors in understudied patient populations at significantly increased risk from adverse events? Or in different words, how muc...