Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How would you approach a patient with limited stage SCLC who progressed immediately after completing chemoradiation with brain metastasis?
For 1-10 brain metastases from SCLC, consider the NRG CC009 clinical trial randomizing between SRS and hippocampal-avoidance WBRT!
Is there an optimal salvage radiation dose for relapsed post-CART disease?
While there is not enough data to definitively recommend a specific dose, we feel an EQD2 > 37.5-40 Gy is desirable for patients with limited residual or relapsed disease post-CAR T-cell. Our commonly recommended fractionations include 37.5 Gy in 15 fractions, 40 Gy in 15 fractions, and 40 Gy in 20 ...
In a patient with recurrent fibrolamellar HCC a year after upfront resection (previously refused adjuvant therapy) with a solitary abdominal mass, would you offer neoadjuvant therapy to assess response?
Recurrent disease is the best care for under clinical trials for FLC. There are not many, sadly because of limited support. But there are some, like NCT03860272.
How do you approach a patient with newly diagnosed high-grade osteosarcoma who received maximum cumulative dose of doxorubicin for a soft tissue sarcoma 10 years earlier?
Some chemo is better than no chemo for osteosarcoma.That is what is known. After the first randomized study establishing that chemo was effective at improving survival for OS, all subsequent randomized studies have been statistical ties. No regimen or schedule or dose or drug has been proven to be b...
Do you recommend sperm banking for males prior to undergoing radiation?
To the first question in the prompt, I would recommend sperm banking for any patient who was receiving a sufficiently high radiation dose to the testes and desired fertility preservation. In my practice, this are few patients, although it is an important consideration for younger patients. To the se...
How would you approach new dermal mets in a patient who recently finished chemoradiation for head and neck SCC?
Dermal mets are M1 disease. Since the patient received chemo, (s)he has a medical oncologist who should manage the case moving forward.
Would you offer XRT as bridging for all patients with limited pre CAR-T disease or as consolidation for only those with residual PET-avidity on day+30 post CAR-T?
There are no studies comparing these 2 approaches. However, given the detrimental outcomes of post CAR-T relapses, I would consider maximizing peri-CAR-T treatments as much as possible as long as the toxicity profile is reasonable, and would not view these 2 approaches as mutually exclusive. I would...
Do you ever repeat screening for acquired von Willebrand in patients with essential thrombocythemia who have high platelet counts and very low risk disease not on cytoreductive therapy?
I generally check on a regular basis (i.e., yearly) to confirm no changes. Obviously, if there is bleeding I would check at that time.
How do you approach patients with node positive sebaceous cell carcinoma of the eyelid for adjuvant chemotherapy and radiation?
Postop RT. I don’t know of data supporting adjuvant chemo.
What would be your approach to first line therapy for patient with metastatic HER2 positive breast cancer with CHF (LVEF <50%)?
I would have cardiology on board and see if EF can be improved with medication. If close to 50% and cardiology feels it's stable/can be improved and can be closely monitored, I may go ahead after coordination with them.