Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
What is your approach to adjuvant systemic therapy for radiation-induced epithelioid angiosarcoma of the chest wall after successful margin-negative resection?
I generally prefer to give neoadjuvant paclitaxel, but in cases such as this where a patient has undergone a margin negative resection, I discuss the limited data supporting adjuvant chemotherapy and after that discussion, will often offer gemcitabine + docetaxel for higher-risk patients, particular...
How would you manage a patient with newly diagnosed locally advanced NSCLC and concurrent, active tuberculosis on anti-TB therapy?
Excellent question @Dr. First Last! Assuming the patient is otherwise a good candidate for concurrent chemoRT, my bias would be to proceed with concurrent therapy once the 3 negative AFBs are available, rather than pursue sequential RT then chemo. This recommendation is based upon the observation th...
What neoadjuvant treatment strategy would you use for an unresectable intrahepatic cholangiocarcinoma with dMMR with the goal of downstaging to achieve surgical resectability?
Would you offer rituximab maintenance for 2 years after a successful response to induction in a patient with splenic marginal zone lymphoma?
The answer will depend on age, performance status of the patient, thrombocytopenia, etc. No difference in OS was noted but freedom from progression was noted in rituximab group. 1 year did as good as 2 years maintenance.Kalpadakis et al., PMID 29914978
Is celiac lymph node involvement a contraindication for chemoradiaton in esophageal adenocarcinoma?
I don't have a particularly insightful or one-size-fits-all answer to this question. I think this is absolutely a situation where the case has to be reviewed in a multidisciplinary context with an experienced thoracic surgeon and radiation oncologist. A PET/CT scan should also be part of the baselin...
How would you manage a patient with localized prostate cancer treated with radical prostatectomy and found to have a single involved pelvic lymph node on final pathology and a detectable postoperative PSA?
This patient is now in the salvage setting with PSA recurrence after RP and with PSA persistence and node-positive disease. This is a grey area of medicine without level 1 evidence from RCTs but there are some sources of data to help guide optimal outcomes. This patient is at high risk for further m...
How would you approach a BRAF negative metastatic melanoma patient on immune checkpoint inhibitor therapy with enlarging, symptomatic brain lesions that had previously been treated with SRS?
Depending on the PS and medical history of the patient, would recommend moving them to ipi (3 mg/kg)/nivo (1 mg/kg) as soon as possible. - Brent Hanks
How would you approach a patient with mediastinal-only recurrence of small cell lung cancer < 6 months after primary surgical resection and adjuvant platinum-etoposide for Stage I disease?
The patient still has limited-stage, potentially curable disease assuming the PET/CT and MRI brain do not show any other sites of cancer outside of the mediastinum. Treatment should consist of chemotherapy plus early concurrent thoracic radiotherapy (TRT). This situation is analogous to mediastinal-...
How do you manage ovarian suppression for premenopausal patients with HR+/HER2 positive breast cancer?
Oophorectomy and GnRH agonist are two options for ovarian suppressive therapy. There are two fundamental differences between these options. First, GnRH monthly, and especially the 3-month depot preparations, will incompletely suppress estradiol levels in some women. 17% to 25% of women on monthly Gn...
In GEJ or gastric cancers, do you routinely image after surgery, prior to resuming systemic therapy?
I typically do restage, especially if there is a delay in resumption of therapy of more than four weeks. I typically restage 1-2 weeks prior to initiating adjuvant therapy to ensure micrometastatic disease has not blossomed into an obvious recurrent disease which would change the intent of treatment...