Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How do you approach imaging in patients with M0 castration-resistant prostate cancer with rising PSA on an ARSI?
I do not use molecular imaging (e.g., PSMA-PET/CT) for patients with CRPC (including both mCRPC and nmCRPC) except as a screening tool for Pluvicto eligibility for three reasons. Most patients have metastasis already. In one study that used molecular imaging in patients with nmCRPC, they identified ...
Would you consider using anthracycline for treating a Stage I triple negative breast cancer in a patient with a baseline mildly reduced LVEF 50-55%?
I'm going to assume this is the clinical stage, and the patient has not yet had surgery. In this arena, if the patient is a fit surgical candidate then there are those who might advocate for taking to surgery up front if they are otherwise healthy. In patients like this, you could have a look at the...
How do you counsel patients regarding timing of dentures after definitive/post-operative H&N radiation with pre-treament tooth extractions?
Wait for at least 3 months for acute healing and for the first post-tx scans to be NED. After that, there can still be subacute changes over the next 6-12 months (post extraction bone resorption, post radiation fibrosis, etc) that would lead a prematurely fabricated denture to lose appropriate fit. ...
How would you approach a patient who underwent a right colectomy for a polyp with high-risk dysplasia with pathology showing no primary but one of the LN showing adenocarcinoma suggestive of GI primary?
This would be a low risk stage-III colon cancer.I find this nomogram/tool on risks helpful in having conversations with patients with stage-3 colon cancer.Sobrero et al., PMID 32892120 ”Large differences in 5-year DFS rate were observed among the subgroups, ranging from 89% (T1N1a) to 31% (T4N2b) in...
How would you treat a patient with metastatic cancer with a lesion invading the small bowel causing bleeding and potential obstruction?
Radiation reliably relieves bleeding but typically does not relieve obstruction. It may be worth trying if there is not an impending obstruction. We have plenty of experience in rectal cancer that this is a successful strategy. Since it's located in the small bowel, I would use standard fractionatio...
What is the timing of onset of alectinib induced ILD, and is there any correlation between dose and the occurrence of ILD?
There is wide variability in the timing of onset of ALK TKI-induced ILD. In a single-institution retrospective analysis published by Koshikawa et al., PMID 32237210, onset specifically of alectinib-induced ILD ranged from day 9 to 531. Risk of ALK TKI-induced ILD was associated with older age and wo...
Would you give adjuvant chemotherapy to a distal esophageal adenocarcinoma T3NxM0 who s/p chemo-radiation and esophagectomy, had a complete pathologic response (ypT0N0)?
For patients with esophageal adenocarcinoma who receive neoadjuvant chemoradiation, there are no data to support the use of adjuvant chemotherapy, irrespective of the pathologic response. However, if the patient does not have a pathologic complete response, adjuvant nivolumab is indicated according ...
How would you treat an essential-like tremor secondary to tumor (e.g. glioma)?
This is a great question. The first step in managing tremor in the setting of a tumor or underlying mass is to first determine the phenomenology. It is not uncommon for dyskinesias like chorea or dystonia to arise after onset of tumor or treatment of tumor. Thus, looking for subtle (or not so subtle...
In which situations do you consider post-mastectomy radiation therapy when the patient has a localized node-positive breast cancer with a complete nodal response and minimal residual disease in the breast post-neoadjuvant chemotherapy?
This is an area of open study as we await the results of NSABP B-51. Off study at this time, I discuss the role of PMRT with all patients, with cN1 patients with a pCR in the nodes. I discuss PMRT is likely to provide a locoregional recurrence benefit, though survival advantage is unclear. Factors t...
Would you change AR signaling inhibitor in a patient with high volume metastatic castration-sensitive prostate cancer who started darolutamide with initial plan for docetaxel but in whom chemotherapy was eventually deferred?
The ARASENS trial showed a survival benefit for the combination of ADT with chemotherapy and Darolutamide in mHSPC. In a patient with high-volume disease who has been initiated on Darolutamide but in whom chemotherapy was planned but then deferred, I would continue with Darolutamide if the patient i...