Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
What is the best adjuvant treatment for resected NSCLC?
This is going to be a several part answer to a seemingly straightforward question. I’ll break this down into a few parts: 1) Which chemotherapy, 2) Targeted therapies in molecular subsets, 3) Anti-angiogenic agents, 4) The role of PORT (post-operative radiation therapy). 1. Which Chemotherapy: The s...
Which older patients with hormone receptor positive, HER2 negative breast cancer should receive chemotherapy?
Discussions with older patients are similar in many ways to the discussions with our younger patients. What is the risk of recurrence (taking into account anatamy and biology), what therapies might impact that risk of recurrence, what are the patient's comorbities, and what are the patients preferen...
When do you perform BRAF testing in colon cancer?
I now perform BRAF testing as close to diagnosis of metastatic cancer as possible. While it is not a predictive test, the prognostic value is important. We discuss prognosis with our pancreatic cancer patients differently than our CRC patients. Now, I think we should discuss prognosis differently wi...
When do you perform HER2 testing in patients with colorectal cancer?
HER2 amplification is seen in a small but distinct subset of colorectal cancer. This subset has 2 unique characteristics: They are predominantly RAS wild type tumors. They do not respond to anti-EGFR agents, i.e. HER2 amplification is a negative predictor of anti-EGFR antibody (cetuximab and panitu...
How do you perform geriatric assessment for cancer patients?
This is a HUGE topic. I would like to suggest the following 2 resources that you may find helpful. https://www.mycarg.org/?page_id=898 and the following one helps predict residual life expectancy independent of cancer diagnosis: https://eprognosis.ucsf.edu
Is there an age cutoff for when to avoid FOLFIRINOX in older patients with pancreatic cancer?
The original Conroy trial had a maximum age of 75 years old; but then the recent PRODIGE 24/CCTG PA.6 adjuvant trial increased the age limit up to 79. I think this reflects the idea that there are still good performing elderly patients who may well tolerate FOLFIRINOX, and I have treated patients in...
Is there an age cutoff for when to avoid Gem/Nab-Paclitaxel in older patients with pancreatic cancer?
I actually have found full dose therapy (1000mg/m2 of gem; 125mg/m2 of abraxane) to be very well tolerated when given on an every other week schedule, which in a retrospective review was as effective as 3 on, 1 off therapy (PMID: 28203300)
When is lanreotide preferred over octreotide in GI neuroendocrine tumors?
As far as I am concerned, the drugs are equally effective, assuming the drugs get delivered correctly. The advantages of lanreotide are, as others have mentioned, a more reliable delivery method being given SC instead of IM. Also, lanreotide has faster absorption and it takes a shorter time to achie...
Should enzalutamide be given concurrently with Sip-T in castration-resistant metastatic prostate cancer?
In the phase 3 trial of sip-T, enzalutamide was not available, and concurrent therapy with anti-androgens was not permitted. In fact, all patients were required to be progressing on ADT and prior therapies to be eligible, and additional anti-cancer therapy beyond the sip-T and concurrent ADT was not...
How do you taper steroids for patients with symptomatic edema following standard chemoradiation for GBM?
I agree with above and would add that decreased production of corticosteroids by the adrenals does not typically occur until after a patient has been on steroids for at least 3 weeks. If you have a patient on steroids for less than this time period I suggest a rapid taper that is based on symptom co...