Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
What is your treatment approach for metastatic squamous carcinoma of the prostate?
There are limited data to guide the management of metastatic squamous cell cancer of the prostate. Outside clinical trials, I have typically treated patients extrapolating from squamous cell cancer of the lung /head and neck literature and have seen responses with gem and cisplatin, 5 FU, pembrolizu...
How do you sequence short course radiation for locally advanced rectal cancer when using the total neoadjuvant approach?
Short answer: No, there is no data suggesting that this regimen and its longer wait is detrimental to operative morbidity for rectal cancer. Long answer: The concern about the delay from TNT, whether short course radiation->chemotherapy OR chemoradiation->chemotherapy prior to surgery has been addre...
What lifestyle changes (if any) do you recommend to patients and caregivers regarding the bodily fluids of patients receiving systemic therapy?
For recommendations related to reproduction (both genders) and lactation, the USPI (a.k.a. FDA label) is a great place to start. Specifically, I refer to subsections 8.1 Pregnancy, 8.2 Lactation, and 8.3 Females and Males of Reproductive Potential of the "Use in Specific Populations" section. These ...
Do you routinely prescribe anticoagulation for patients on active chemotherapy?
This is dependent on the risk factors of the patient for the development of VTE. Recently published ASCO guidelines (JCO 2019) incorporated the additional recommendation of VTE prophylaxis for high risk outpatients receiving chemotherapy with either eliquis, xarelto, or LMWH. The Khorana scoring sys...
How long should breast cancer patients whose surgeries are delayed due to COVID-19 remain on neoadjuvant endocrine therapy?
How long to continue neoadjuvant endocrine therapy (NET) when it was initiated for the purposes of COVID-19 management depends on several variables, including whether the tumor is at least stable on NET (if not, then conversion to surgery or chemotherapy is appropriate), and what the COVID-19 trajec...
Should new patients requiring chemotherapy be tested for COVID-19 prior to starting treatment?
At Vanderbilt, we are testing asymptomatic patients for COVID if they are getting a 'high-risk' regimen, which we have empirically defined as: CAR-T cells, BMT, combined chemo/XRT, regimens normally requiring growth factor support etc. There are not great data to advise on specific risks for specifi...
Would you offer systemic therapy after rendered NED from SRS to isolated CNS metastases in a patient with prior curative intent treatment of lung adenocarcinoma and clear cell RCC?
What is the best approach for patients with DLBCL with early relapse (< 6 months) after initially attaining a CR with 6 cycles RCHOP?
Early relapse, regardless of interim imaging, suggests chemorefractory disease. It may be that we selected a more chemo/rituxan resistant clone that comprised a smaller % initially that has now become dominant. Regardless of pathophysiology, I think for today we are stuck with the same paradigm: sal...
How are you counseling HR-proficient ovarian cancer patients about front line PARP inhibitor maintenance?
I think this is a tough decision, but I recommend observation for patients with HR proficient disease. In brief, I don't find a PFS advantage, without a proven OS advantage, enough to justify this long-term, expensive, and not non-toxic treatment.For BRCA carriers the answer is easier—with SOLO2 (20...
Does ER+ status impact your choice of neoadjuvant systemic therapy in premenopausal women with cT2N0 HER2+ breast cancer?
In general for T2N0 HER2+ breast cancer, I would recommend neoadjuvant TCH or AC-TH, or one of those regimens + pertuzumab, with the decision about inclusion vs omission of pertuzumab based on the limited absolute benefit in APHINITY for node negative breast cancer; but understanding that with a neo...