Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How do you decide between systemic vs. arterially directed therapies in the first line setting for unresectable HCC?
In IMbrave150, 63% of patients treated with atezolizumab/bevacizumab had extrahepatic spread of disease, and my recommendation for patients with extrahepatic involvement is for first line systemic therapy. For patients with unresectable disease without extrahepatic spread, we take a multi-disciplina...
How would you treat newly diagnosed good risk stage III seminoma with hearing loss?
In order to treat a newly diagnosed stage 3 seminoma in a hearing-impaired patient, my first step is to have the pathology confirmed by an expert GU-tumor pathologist to ensure that this is not actually NSGCT nor large cell lymphoma. While that is in process, I ensure that baseline tumor markers hav...
In ES-SCLC presenting with limited asymptomatic brain metastases and treated upfront with systemic therapy alone (carbo/etop/atezo), how would you approach the brain if MRI shows PR after a few cycles?
In our practice, we would typically watch such a patient on systemic therapy. However, we would stress the need for vigilant monitoring and likely administration of RT (SRS ideally) at the carbo/etop/atezo transition to atezo monotherapy, given the poor intracranial efficacy of the maintenance syste...
How would you treat metastatic colon cancer in patients on dialysis?
Fortunately, our standard regimen of 5FU and oxaliplatin are quite safe to administer for patients with chronic renal insufficiency/on dialysis: - 5FU is cleared through non-renal mechanisms and does not require any dose adjustments - BUT...exposure to capecitabine is higher in patients with renal i...
When (if ever) would you offer adjuvant sunitinib to a patient with chromophobe renal cell carcinoma?
To date, evidence is lacking to recommend adjuvant TKIs in chromophobe and other non-clear cell RCCs. The subgroup analysis in ASSURE trial (Lancet Oncology 2016, EA E2805) did not show any benefit of adjuvant sunitinib or sorafenib in nonclear cell RCCs (including 111 patients with chromophobe RCCs...
When consolidating DLBCL with radiotherapy, do you treat all originally involved sites, or just initially bulky and partial responder sites?
When consolidating DLBCL with radiotherapy, several parameters must be taken into consideration. a) Is radiation therapy part of the treatment plan "on top" of full systemic treatment because of a certain risk situation due to not-optimal response of disease to systemic treatment (for example, FDG-a...
Is enteric-coated aspirin acceptable to use in polycythemia vera or ET?
Admittedly, this is a question I had not considered before viewing this query, as I rarely, if ever, prescribe enteric-coated aspirin. In the absence of a bleeding diathesis such as von Willebrand disease, platelet count greater than one million/mm³, or active GI bleeding, low-dose aspirin (75/81/10...
Is enteric-coated aspirin acceptable to use in polycythemia vera or ET?
Admittedly, this is a question I had not considered before viewing this query, as I rarely, if ever, prescribe enteric-coated aspirin. In the absence of a bleeding diathesis such as von Willebrand disease, platelet count greater than one million/mm³, or active GI bleeding, low-dose aspirin (75/81/10...
What are your top takeaways from ASCO GU 2026?
I would highlight the NCI study of PSMA PET/CT monitoring of patients with biochemical relapse (Melissa Abel and Ravi Madan) and Johann de Bono's PSMA x CD3 bispecific.The NCI study is one of the most thought-provoking in terms of what PSMA PET/CT findings may really mean, since no one has done a na...
How do you sequence Pluvicto vs docetaxel in a fit, chemotherapy-naïve patient with high-volume PSMA-avid mCRPC progressing on an ARPI?
I generally favor starting with docetaxel, though both are reasonable options. CCTG Study PR21 did not show a difference in radiographic progression-free survival between starting with docetaxel versus starting with Pluvicto in this setting. However, OS favored patients who started with docetaxel, a...