Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How do you dose FOLFOX when given with concurrent chemoradiation in esophageal adenocarcinoma?
I don’t use FOLFOX within this setting.
How do you approach patients with polypoid/nodular melanoma for adjuvant therapy when Breslow depth is not available on pathology?
If it is nodular, the depth of invasion (Breslow) starts from the outer edge of the lesion vertically down and perpendicular to the dermis, so most likely if polypoid, it will be at least 3 or 4 mm, thus T3 or T4. If ulcerated, T3b or T4b.
Can you use NGS panels or ctDNA to help you find organ of origin in the workup of carcinoma of unknown origin?
At least 2 NGS panels available in the US now offer tumor of origin (TO) profiling. Both Tempus and Caris offer such testing. There are other panels out there using different methods such as epigenetic profiling and WGS. How much this testing improves diagnosis and outcomes is not clear and 2 trials...
What systemic treatment do you utilize for patients with metastatic fibrosarcomatous DFSP that have progressed on imatinib?
Unfortunately, these fibrosarcomas do not respond well to other TKIs. Modest activity of standard STS chemotherapy.
What post-auto maintenance therapy do you recommend for patients with high-risk multiple myeloma?
This is tough. You want each particular risk group to correspond to a maintenance treatment that is likely to benefit the patient - not too much nor too little. The definition of high risk has changed from one single characteristic or one cytogenetic abnormality to a more additive model such as the ...
Would you recommend neoadjuvant chemotherapy for a 3.5 cm low-grade UTUC in a cisplatin-eligible patient?
Neoadjuvant chemotherapy (NAC) conceptually makes sense in UTUC. A number of retrospective studies showed improved surgical and oncologic outcomes with NAC in UTUC. A recent phase 2 clinical trial (Coleman et al., PMID 36603175) confirmed this (63% pathologic response, improved PFS and OS) using spl...
In a patient with very high risk prostate cancer opting for prostatectomy, when, if ever, do you recommend neoadjuvant ADT?
I generally do not offer ADT with or without a potent ARSI prior to RP even in high risk disease. While small single arm studies have shown that a few such men can achieve a pathologic CR and that path CR/MRD is associated with better outcomes after RP, for most patients, this approach has no clear ...
How long do you treat with immunotherapy patients with MSI-high T4B initially unresectable colon adenocarcinoma?
Immunotherapy is an established treatment option for dMMR/MSI-H metastatic colorectal cancer (mCRC) but its optimal duration remains to be determined. A fixed duration of 2 years or until progression or toxicity has been adopted based on the KEYNOTE-177 study. More recently, the GERCOR NIPICOL phase...
How would you treat a patient who received 2 cycles of R-CHOP for DLBCL who was subsequently diagnosed with follicular lymphoma?
It looks like the patient has t-FL. More information is needed: what prompted the biopsy after 2 cycles of R-CHOP? Is his disease progressing after 2 cycles of R-CHOP?
Would you offer capecitabine re-challenge for a patient with metastatic breast cancer and a history of coronary vasospasm?
Doing a 5FU/capecitabine rechallenge after vasospasm can be risky and fatalities have been reported. Capecitabine and infusion 5FU are riskier than bolus 5FU due to prolonged exposure of the endothelium to metabolites. In the US, we lack access to safer alternatives like S1. There are some reports o...