Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Based on data from CREATE-X/JBCRG-04, would you consider adjuvant capecitabine in breast cancer patients treated with neoadjuvant chemotherapy who do not achieve a pCR?
Yes, 6-8 cycles of adjuvant capecitabine has been shown to improve survival in one randomized trial and therefore should be offered and disused with a patient. If capecitabine is given it could be given after surgery followed by radiation therapy or radiation may be completed first. Both options wer...
Based on the recent disease-free survival results from ABCSG-18 presented at San Antonio, do you favor the use of Denosumab in the adjuvant setting?
I'll give you the simple answer first - YES. In those receiving AI adjuvant therapy (whether postmenopasual or pre with ovarian suppression/ablation). We've struggled with how (and whether) to use bisphosphonates in the adjuvant setting. The meta-analysis found a significant improvement of similar m...
Which patients would you offer a watch-and-wait approach versus surgical resection after chemoradiotherapy for patients with rectal cancer?
I would never offer watch and wait as an alternative, even in the patients with an apparent clinical complete response, and I would attempt to dissuade any patient from pursuing this approach. Even after apparent clinical complete response, we frequently see pathologic evidence of residual disease. ...
Is there a role for docetaxel for men with high risk prostate cancer receiving radiation and androgen deprivation therapy?
Standard of care for high risk localized prostate cancer remains radiation and long term androgen deprivation therapy. To date, there are no trials that have demonstrated an overall survival benefit with the addition of chemotherapy. Given the potential toxicity of adding chemotherapy, this should n...
Is there evidence to support routine use of adjuvant chemotherapy for resected rectal cancer treated with pre-operative chemoradiation?
We settled this question in 1985 with the GITSG study showing chemo, or radiation were better than observation and the combination had the best survival (GITSG, NEJM 312,1465, 1985). Whether you administer radiation or systemic therapy before or after surgery is irrelevant but all three modalities h...
Do you transfuse anemic head and neck cancer patients undergoing chemoradiation?
No, never have.
Would you offer adjuvant TKI to patients with Stage III, EGFR-mutant NSCLC after standard chemoradiation?
I would definitely not use adjuvant erlotinib after either surgery or radiation at the current time. The data do not support this, and it is has significant toxicity. Not statistically significant means that the data are likely to have come out this way by chance. The disease free survival tended to...
Do you routinely recommend prophylactic cranial irradiation for stage I small-cell lung cancers treated with lobectomy and adjuvant chemotherapy?
PCI was 'associated' with better long-term survival even in stage 1, and age and size factors do not seem to matter. However, as the information gets divided, fewer patients fall into each cohort.A recent study published in the JCO, analyzing over 1,000 patients in the NCDB, found that thoracic radi...
Is there any role for radium-223 early in the course of castration-resistant prostate cancer with bone metastases?
In the ALSYMPCA trial, there was a demonstrated benefit of radium-223 on survival and skeletal event delay, regardless of prior docetaxel (Hoskin et al Lancet Oncol 2014), indicating that it is not necessary to give docetaxel first before radium and that radium has clear activity in earlier mCRPC (s...
For high risk, stage I, non-seminomatous testicular germ cell tumors, are there particular circumstances under which RPLND is clearly preferred over chemotherapy or surveillance?
There are few indications for primary RPLND in pure nonseminomatous CSI. The only one I can currently think of is someone who has a strong contraindication to ever receiving chemotherapy.... renal failure or the like. The only time I consider it general is for patients with high risk Leydig or Serto...