Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How would you manage anastomotic site recurrence of colon cancer 3 years after resection of a T3N0 tumor without high-risk features?
I will do metastatic work up. If negative:- FOLFOX.
How often do you follow ferritin and organ iron-deposition in a patient who has known hereditary hemochromatosis, but no current evidence of iron overload?
Once diagnosis is made, I stress blood donation or less optimally, therapeutic phlebotomy. If donation every 56 days until ferritin <100 and TSAT <30. This assumes asymptomatic without LFT abnormality. Thereafter the intervals can be adjusted to keep parameters in the desired range. I never follow o...
How do you manage small oropharyngeal cancers with N1 or N2 disease?
For T1-2N1 oropharyngeal cancers there is data from MD Anderson and Toronto that they do quite well with RT alone. These patients are excluded from current RTOG chemo-RT protocols. It is possible that more advanced tumors that are HPV(+) in non- or remote smokers will also do very well with RT alone...
Do you ever give postoperative chemoradiation in patients who underwent preoperative chemotherapy for gastric adencocarcinoma?
This is not a particularly data-driven approach, as the MAGIC trial did not give post-operative chemoradiation (and most patients did not tolerate the planed post-operative chemotherapy), while INT-0116 did not give pre-operative chemotherapy. We don’t have data demonstrating that combining the two ...
Which regimen is better for gastric adenocarcinoma- neoadjuvant chemotherapy or adjuvant chemoradiation?
There are common criticisms of both the MAGIC and INT-0116 trial results.In the MAGIC trial consisting of preoperative (3 cycles ECF) and postoperative (3 cycles of ECF) vs surgery alone, there was inconsistent preoperative staging.. Lymph node dissections were left to the discretion of the surgeon ...
For rectal cancer with solitary liver metastasis, do you recommend neoadjuvant chemoradiation?
If the patient is being managed with curative intent (i.e. there is a plan for surgical resection of both the rectal and liver tumors), then preoperative pelvic chemoRT is reasonable for the same reasons it's indicated in the non-metastatic setting. This is a scenario where we often entertain short-...
In light of the 2 negative bevacizumab trials for up-front GBM, how do you feel about the future of bevacizumab in GBM?
At the 2010 ASTRO meeting, Dr Inder Verma of the Salk Institute gave a very nice keynote address talking about his work using a mouse model of GBM where the GBM cells themselves can morph into vessels as needed, with no expectation of response to anti-VEGF therapy. The work was published a while bac...
What is your approach for a locally advanced (stage IVA secondary to N2 disease in the neck), HPV-negative, squamous cell carcinoma of the base of tongue in a patient without significant comorbidities?
In short, we usually do definitive chemorads. However, this question is more complicated than it seems. With TORS/TLM, surgery seems an option for early Tstage disease, as it is in HPV +ve disease. I believe one of the national studies will try to address this question.For more advanced T-stage, Eve...
Do you give chemotherapy for focal triple negative breast cancer?
not if DCIS with micro invasion.. what is the size of invasive component??
When do you recommend consolidative XRT for patients with advanced stage (III-IV) DLBCL who achieve CR to chemoimmunotherapy?
The cornerstone of therapy for advanced DLBCL is chemoimmunotherapy (R-CHOP). Efforts to improve upon this with systemic therapy have been largely unsuccessful (dose-dense chemotherapy, maintenance R, more intensive chemotherapy, high-dose chemotherapy and autologous SCT, etc.). There are increasing...