Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How do you approach the treatment of patients with widespread ES-SCLC with a poor performance status?
My basic philosophy for the initial treatment of people with ES-SCLC (or LS-SCLC) with poor PS is to just try to get them going in the right direction without killing them with my treatment. SCLC is usually very responsive to chemotherapy, so you don’t have to beat people with full doses of the drug...
Do you routinely add endocrine therapy to anti-HER2 maintenance therapy after 6 cycles of THP for metastatic ER+ HER2+ breast CA?
Yes, if I am treating triple positive, I generally add ET to HP regardless of whether the patient received THP or not. The therapeutic window is wide, and likelihood of cross-talk interfering with long-term anti-HER2 effectiveness is high. While not tested systematically, HP alone is likely a relati...
Would you consider stopping maintenance immunotherapy for ES-SCLC after 2 years for exceptionally responding patients?
If therapy is well tolerated, I support indefinite use. While it is rare to see late recurrence in NSCLC after 2 years, I have seen late recurrence regularly in SCLC.
How would you time COVID-19 vaccination with someone on R-CHOP chemotherapy?
It is really hard to time COVID vaccine while on chemo. Although ideal time would be as far away from chemo as possible (3-6 months) or 6 weeks before chemo starts, that is not practical in someone getting q 3 week R-CHOP. I would recommend giving it when available and if possible, time it on a diff...
How would you approach older patients who are not fit or frail with stage 1 favorable classical Hodgkin lymphoma?
The change in therapy for early stage HL from RT alone to chemotherapy usually with low dose consolidation RT was not because of lack of effectiveness of RT but rather because of concern for long term complications. HL cause specific survival for early stage disease treated with RT alone or combined...
When are you recommending bone marrow transplant recipients receive the SARS-CoV-2 vaccine?
The CIBMTR and EBMT data indicate a 20-30% mortality in transplant patients. Risk factors are age >50, male, and <12 months from HSCT. Unfortunately, the complexity of immunological recovery after transplant makes inferring the likelihood of response to a new vaccine formulation impossible. In gener...
Do you have any special diagnostic or treatment considerations when evaluating never-smokers with metastatic small cell lung cancer?
There is an increased risk of developing small cell lung cancer (SCLC) with prolonged exposure to radon, although not all studies have found this association in never smokers (Barros-Dios et al., PMID 22539606). It wouldn't hurt to ask if the home has been tested.I would be very interested in sendin...
What are the current official guidelines regarding COVID-19 vaccination for patients with cancer or for hematologic conditions?
There are a number of resources available to guide clinicians on these decisions. I recommend the COVID-19 Resources webpage curated by the American Society of Hematology (COI, I'm the editor of that website). https://www.hematology.org/covid-19 This website includes guidance on immunizations in the...
Would you offer immunotherapy for recurrent metastatic Ewing sarcoma if the tumor is MSI high or has high TMB?
Limited data available (e.g.from SARC 028 - Tawbi et al., PMID 28988646) does not suggest any reasonable activity of CPI in Ewing sarcoma subset. Treating the patient on a "basket trial" of TMB-H or MSI-H would be reasonable, but not as standard of care.
For a patient with H&N squamous cell carcinoma who underwent salvage neck dissection for residual disease following primary chemoradiation with weekly cisplatin, do you offer any adjuvant therapy thereafter if extranodal extension is found?
Here the situation should be clarified and can be nuanced. If the initial chemoradiation was unilateral and the relapse now in the unirradiated neck, then yes, adjuvant chemoradiation is indicated (radiation alone if frail or elderly). If that relapsed neck was already radiated then adjuvant re-irra...