Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How do you manage a Ta pure squamous cell carcinoma of the urinary bladder?
The ideal management of non-muscle invasive bladder cancer (NMIBC) with histologic variants remains controversial. The American Urological Association and the National Comprehensive Cancer Network guidelines recommend radical cystectomy for T1 patients with variant histology based on expert opinion ...
Should immune checkpoint inhibitor be held for palliative RT to bladder in patient with metastatic urothelial carcinoma who has stable systemic disease on immunotherapy?
I assume the scenario applies to patients with good systemic disease control on immune checkpoint inhibitor (ICI) but with symptomatic primary tumor of the bladder, e.g. hematuria, pain, and obstruction. It is helpful to have a good discussion between Med Onc & Rad Onc regarding the optimal timing, ...
What is your approach and preferred first line treatment regimen for advanced/metastatic adenosquamous NSCLC?
As with all advanced lung cancer, the answer to this question depends upon molecular characteristics and PDL1 status. I would perform NGS (next generation sequencing) analysis of all adenosquamous cancers (by tissue, and if uninformative, potentially ctDNA testing) as well as PDL1. As I tell all of ...
How would you treat active rheumatoid arthritis in a patient in complete response on loralatinib for stage IV ALK positive NSCLC?
I would do my best to minimize immunosuppression. I would use IL-6 or Abatacept and possibly rituximab. Have done all to minimize DMARDs and have had success with all 3.
What are your recommendations regarding sexual activity for a couple when one of them is diagnosed with a HPV-positive oropharyngeal cancer?
We always counsel patients regarding the etiology of HPV if they have a p16+ tumor. We tell them that this is an infection most likely acquired through sexual activity and that the latency period is approximately 20 years from the time of exposure until the time of a cancer diagnosis. We note that o...
How would treat a patient with good performance status with PTCL-NOS found to have leptomeningeal disease during treatment course with CHOEP?
I haven’t combined CHOEP with high dose methotrexate before! I have treated a patient with HIV-associated B-cell lymphoma with R-EPOCH and high dose methotrexate at D15 successfully with growth factor support. For patients with PTCL-NOS and leptomeningeal involvement at presentation, I would likely ...
What would your next line treatment be for a patient previously treated with repeat resection, craniospinal irradiation, and initial cisplatin/vincristine/CCNU with medulloblastoma?
As you will agree, this is an extremely unfortunate situation. I am assuming this patient has progressed either while on therapy or soon after completion? Depending on his age, a potential option is to enroll him on any available clinical trials. PBTC58 study uses intrathecal omburtumab along with c...
Would you still offer adjuvant osimertinib to patients who elect not to receive chemotherapy in resected EGFR mutated lung cancer?
Yes- while it is important to keep in mind that platinum-based adjuvant chemotherapy confers OS benefit in the appropriate setting, adjuvant chemotherapy prior to osimertinib/placebo randomization was not mandatory in the ADAURA study design. In the updated analysis presented at ESMO 2022 by Tsuboi ...
For Siewert 3 locally advanced GEJ adenocarcinoma, when do you offer preop chemoradiation (CROSS regimen) vs periop chemotherapy (MAGIC or FLOT)?
Siewert I/II GEJ adenocarcinomas are treated according to esophageal cancer algorithms, while Siewert III GEJ adenocarcinomas are treated according to gastric cancer algorithms. Consequently, perioperative chemotherapy with FLOT is the standard, evidence-based approach for fit patients with Siewert ...
How would you manage an older, frail ECOG 2 patient with stage II muscle-invasive bladder cancer with other competing risk of death?
Conceivably, treatment options are extremely limited for older, frail patients with localized muscle-invasive bladder cancer, who are not candidates for cystectomy or radiation. TURBT is a common practice in this patient population (Trulson et al., PMID 23817891), but without any improvement in outc...