Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Should a patient who requires definitive treatment for prostate cancer as a pre-transplant requirement be strictly required to complete their course prior to transplant/initiation of immunosuppression?
To help address this complex question, I would like to call your attention to a review of the topic by Al-Adra et al., PMID 32969590. It covers several types of malignancies, including prostate cancer (Table 4). Treating this patient will require close collaboration with the transplant surgeon, urol...
What are your top takeaways in GU Cancers from ESMO 2025?
KEYNOTE-905: These impressive results change the management paradigm of patients with MIBC who are surgical candidates but are not cisplatin-eligible. Over time, it may be that EVP perioperative therapy becomes the standard of care for all patients with MIBC with plans to proceed with cystectomy. I...
What is optimal endocrine therapy in a young, premenopausal women with ER/PR positive oligometastic breast cancer successfully treated with curative intent neoadjuvant chemo followed by surgery+RT to skeletal oligomet?
These cases are always important to understand what discussions were had up front with the patient and all members of the team regarding goals of care. It seems the patient was treated with "curative" intent; however, the likelihood that she has actually been cured of her disease is extremely low an...
Would you consider using transdermal estrogen in a patient with “high risk” APLS patient on warfarin?
Given her clinical diagnosis of high-risk APS, I would first trial nonhormonal therapies or progesterone-only therapies for management of her post-menopausal symptoms. Current ACR guidance recommends against hormone replacement therapy in patients with APS on anticoagulation (Sammaritano et al., PMI...
Do you discontinue an aromatase inhibitor in a patient if they have a cardiac event while on the drug?
Randomized clinical trials and several meta-analyses that compared tamoxifen with aromatase inhibitors (Khosrow-Khavar et al., PMID 32065766 is a more recent one) demonstrated statistically significant increase in the rate of cardiovascular events in women taking aromatase inhibitors although the ab...
In patients with cancer of unknown primary, do you routinely send molecular testing to help determine primary tumor origin?
The NCCN designates tumor sequencing and use of gene signature profiling as a category 3 recommendation. This is more or less consistent with NIH and ESMO guidelines in that that the impact on patient outcome remains questionable and unproven.There are multiple commercial assays in this space. The p...
Would you use routine PET scans after two cycles of R-CHOP to guide first-line treatment de-escalation in low-risk (aaIPI = 0) DLBCL patients?
This phase III trial suggests that in very low-risk limited-stage DLBCL (aaIPI = 0), patients who achieve a negative PET after two cycles of R-CHOP can safely receive only four total cycles instead of six, with similar 3-year PFS (92% vs 89%) and less toxicity. However, the results apply to a highly...
Would you use routine PET scans after two cycles of R-CHOP to guide first-line treatment de-escalation in low-risk (aaIPI = 0) DLBCL patients?
This phase III trial suggests that in very low-risk limited-stage DLBCL (aaIPI = 0), patients who achieve a negative PET after two cycles of R-CHOP can safely receive only four total cycles instead of six, with similar 3-year PFS (92% vs 89%) and less toxicity. However, the results apply to a highly...
When do you order genetic studies such as comparative genomic hybridization for melanocytic lesions?
In my practice, I confine copy number alteration studies (SNP array testing) for cases where the biological potential of a melanocytic proliferation is in question. I do not perform the testing if the case is diagnostic histopathologically and/or immunohistochemically of a nevus or melanoma.The seco...
How do you approach relapsed idiopathic HLH?
This question is quite non-specific - the answer depends very much on the specific context (child, adult, relapsed after what treatment?) and as such, can only be answered in broad strokes.First, ensure that it is truly idiopathic – check EBV, CMV viral loads, and other viral/infectious triggers as ...