Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How would you manage a patient with EGFR mutant adenocarcinoma of the lung on erlotinib with a single site of disease progression, but otherwise well-controlled disease?
This is a point of controversy. There are multiple reasonable options to consider for such a patient: Keep going with tarceva and follow the lesion carefully. The NCCN guidelines actually acknowledge this approach for asymptomatic disease. Use SRS or some other locally ablative approach to destro...
When is the best time to start denosumab in men with metastatic prostate cancer?
The data supporting the use of bone modifying agents (BMAs) such as denosumab or zoledronic acid are certainly the most solid for men with castration-resistant prostate cancer (i.e. progresion of disease through inital LHRH analog therapy) (Saad, JNCI 2004; 94: 1458–68; Fizzazi Lancet Oncol 2011; 37...
What mutational testing is considered the standard of care for NSCLC?
The easy answer to this question is that the only molecular alterations for which we have matched FDA-approved drugs for those specific indications are EGFR and ALK, so the standard of care would be to test only for EGFR and ALK. However, over the past 2-3 years, we came to appreciate that several o...
Do you treat rectosigmoid/upper rectal cancers with neoadjuvant chemoradiation?
The 12-year update to the phase III pre-op RT Dutch rectal trial found a local control benefit with RT regardless of location (VanGijn et al., Lancet Oncol. 2011; 12(6):575-82.). In the Dutch update, tumor location was analyzed as a continuous variable. This is different from the every 5 cm cut-offs...
Is there a role for consolidation radiation in a patient with stage I low grade follicular lymphoma treated with chemotherapy?
First, while there is no "standard" treatment for stage I follicular lymphoma due to a scarcity of randomized studies, most North American and European guidelines indicate that the "preferred" treatment is radiation therapy. This is based on several single institution series demonstrating that radia...
For patients with stage 1A-E extra nodal marginal zone lymphoma that has been completely excised, would you still consider radiation?
Not if it has been excised completely
Should one perform a sentinel node biopsy in a clinically negative axilla prior to neoadjuvant chemotherapy?
For an upfront clinically and radiologically negative axilla, where the SNLN is negative for disease after chemo, we don't change our RT field. For an upfront clinically and radiologically negative or positive axilla where SNLN is positive even after chemo, then normally they undergo full dissection...
Is weekly Cisplatin considered a valid alternative to Cisplatin cycles every 3 weeks as part of definitive chemo-radiation for muscle invasive bladder cancer?
None of the RTOG trials had this approach, but extrapolating from head and neck cancer (cisplatin 30mg/m2) or cervical cancer (40mg/m2), people in the community are using weekly cisplatin. As far as data, there is a phase II study from Australia utilizing cisplatin 35mg/m2 weekly for 6-7 cycles show...
Is there a role for post-operative chemoradiation therapy in fully resected, margin-negative T3N1 NSCLC?
I assume you're talking about T3 for chest wall invasion, and I think the answer is probably no routine role for RT for this individual risk factor. If you look at surgical series, invasion of the chest wall IS a risk factor for both positive surgical margins, and local recurrence. But if you limit ...
For breast cancer patients requiring staging, should one order a CT C/A/P & bone scan or PET scan?
For locally advanced disease (T4 or N2), I would favor PET/CT because of the higher yield for identifying metastatic disease. It is also important for the radiation oncologist because of the higher likelihood of identifying of involved IM nodes and level 3a and supraclavicular nodes which can change...