Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
When would you use concurrent cetuximab with radiation for a patient with H&N cancer who is not a good candidate for concurrent chemotherapy?
Additional data has been added since I have addressed this question in 2015: the role of concurrent cet-RT in HNC patients who cannot receive chemotherapy. The large majority of these patients are elderly with heavy smoking/drinking history, and typically have non-HPV related Sqcca associated with p...
Should the incorporation of thoracic RT be standard in patients with extensive stage small cell lung cancer?
The jury is really still out on the issue of whether or not to add thoracic radiation therapy to prophylactic cranial irradiation (PCI) in patients with extensive-stage small cell lung cancer. The published data cited above, Slotman et al. in Lancet last Fall 2014, indicate that there may be an over...
Would you treat a patient with small cell lung cancer (limited to lung and mediastinum) but also with a malignant pleural effusion with upfront definitive thoracic chemoradiation?
I would treat such a case as EXTENSIVE DISEASE. That means chemotherapy with 4 cycles of Plat/Etop, and restage with PET. If the pleural disease has gone by imaging or/and pleural tap, I would add thoracic radiotherapy 30 gy/10 fractions and PCI 2.5 gy X ten. If the pleural space remains positive, I...
Can chemotherapy be used instead of radiation therapy in a patient with extensive stage small cell lung cancer who presents with epidural spinal cord compression?
I think it would have to be done on a case-by-case basis, and the answer is likely "Not a good idea." Chemo can make SCLC shrink a lot, but you'd really have to monitor day by day with CAT scans. And it unlikely to take the pressure off the spinal cord arteries within hours to days, as is needed. Th...
Should immunotherapy be standard of care for metastatic MSI-high colorectal cancer?
It should be a treatment option but not yet in the first line. My first option for MSI-H patients is to enroll in an immunotherapy trial. If not available, I'll usually reserve single-agent PD-1 inhibitors until after second line therapy. Recent data suggests that the Ipilimumab-nivolumab combo migh...
Do you omit anthracyclines in perioperative chemotherapy for gastric cancer?
The available data would suggest a very small benefit, if at all, for anthracyclines in the locally advanced setting.Although the MAGIC study established ECF as a standard-of-care, a contemporaneous French FFCD study revealed nearly identical outcomes with 5-FU/cisplatin alone.More recently, the res...
Which embolization approach is preferred for liver metastases from well differentiated neuroendocrine tumors?
Treatment options for metastatic GEP-NETs have evolved in recent years including PRRT which definitely affects our decisions for when and who will be eligible for liver-directed therapies (LDTs). In general, LDTs are appropriate for patients with G1/2 well diff. diffuse, unresectable liver metastas...
When do you give treatment breaks for patients with NSCLC undergoing chemoradiation with serious toxicity?
I agree with @Dr. First Last's approach. I am very aggressive in not introducing treatment breaks during radiotherapy. One approach that I occasionally use to "make up" for dose issues when a break is inevitable is to accelerate at the end of treatment to make up for the break rather than to specifi...
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...