Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How would you approach chronic isolated severe non-cyclic neutropenia with negative bone marrow and rheumatologic work-up?
My preference would be to use G-CSF at the lowest effective dose, i.e., the dose that maintains the ANC >1000. The risk of inducing leukemia is low in individuals with idiopathic, chronic neutropenia, but it is positively correlated with the G-CSF dose. There are also other side effects like bone pa...
Do you routinely monitor CEA in addition to CA 19-9 in patients with pancreatic cancer?
Yes. All patients are monitored serially with CEA and CA 19.9. If bilirubin is elevated due to obstruction rather than hepatic metastases, CA 19.9 elevation relates to obstruction rather than cancer status. In patients who do not have elevated CEA or CA 19.9 on presentation, we utilize ctDNA as a ma...
How do you manage cancer treatment-related cognitive change or "chemo brain?"
Chemo-brain is a vexing and complicated diagnosis. In most cases, you don't know the baseline neurocognitive function of individuals with cancer. Many conditions that are associated with chemotherapy like fatigue, depression, and aging can mimic chemo-brain. Estimates are that about 20% of individua...
What surveillance plan would you recommend for stage IV melanoma patients who achieve a CR or stable PR response with immunotherapy?
If melanoma patients have achieved CR or PR after a year of immunotherapy treatment, I highly recommend participation in this ongoing ECOG cooperative study: EA6192 / PET-Stop Educational Materials - ECOG-ACRIN Cancer Research Group (NCT04462406). The study uses PET scans in combination with contras...
How would you manage a patient with isolated metastatic high grade sarcoma to inguinal and external nodes in a patient with BRCA+ mutation?
Ovarian cancer treatments can work for BRCA2+ leiomyosarcoma.This has been published (Seligson et al., PMID 30541756) and I have had a couple of patients with BRCA2+ LMS. I had no luck with PARP inhibitors but one tremendous success with cisplatin, which produced a dramatic response in one heavily p...
What are the benefits and risks of using medical marijuana for cancer related symptoms?
The 2020 ASCO Antiemetic guidelines state that the evidence remains insufficient to recommend medical marijuana for either prevention or treatment of N/V in patients receiving chemotherapy or radiation therapy.There is insufficient evidence to recommend inhaled cannabis for cancer-related side effec...
What chemotherapy would you utilize for a metastatic dysgerminoma diagnosed in the second trimester of pregnancy?
Cisplatinum, Etoposide, Bleomycin
Can immunotherapy, alone or with chemo, be considered for ROS1+ NSCLC after exhausting ROS1 targeted therapy options?
Following evidence in more common driving mutations (especially those not associated with a history of tobacco use), I would not recommend immunotherapy alone for this group. When using chemotherapy, it is reasonable to consider adding immunotherapy, but there is no strong evidence to support it.
How do you decide on first line treatment for a patient with metastatic colon cancer with dMMR, a HER2 mutation and no mutations in KRAS or BRAF?
Would you consider perioperative chemotherapy in an anastomotic recurrence of gastric cancer after partial gastrectomy who did not receive prior chemotherapy or radiation?
My practice is to treat this exactly like de novo locally advanced disease. This means that the patient needs to be carefully (re-)staged, including with PET/CT scan, possibly an EUS, and most importantly, a diagnostic laparoscopy. Recurrence at the anastomosis can certainly also be associated with ...