Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How do you manage dabrafenib fever?
Tough problem to manage. I've tried numerous strategies with unpredictable success. Prednisone 5mg BID usually works if you want to keep full dose. Otherwise, a dose delay and likely reduction of dab will be necessary.
When should SBRT be offered to oligometastatic bone disease in a patient with prostate cancer?
Recently a multi-institutional analysis set standards for use in prospective assessment of SBRT for use in men with > 1 bone metastasis and up to 3 (data shown below). The Rx was well tolerated and local control was significantly improved if a BED > 100 Gy was utilized. At this time this approach re...
How do you approach muscle invasive bladder cancer in an elderly patient who cannot tolerate chemotherapy?
Although the ideal approach is chemoRT, if patient can't tolerate chemo (if cisplatinum is contraindiacted, 5FU amd MMC is an alternative), then RT to a definitive dose is a reasonable alternative. In the UK randomised study, the control arm of RT alone had about 50% LRC at 2 yrs. For patients with ...
Would you treat a muscle invasive urethral recurrence of bladder cancer with definitive chemoradiation?
Assuming that the urethral tumor is invasive of the prostatic stroma, there are multiple reasonable answers depending upon the patient's age and health status. Remember that stromal invasion is a bad sign and these patients are rarely cured. If the patient is young, but reluctant to consider cystopr...
How do you manage postoperative residual disease after neoadjuvant chemoradiotherapy and surgery for a patient with locally advanced esophageal or GE junction adenocarcinoma?
Do you recommend adjuvant chemoradiation for T2N0 gastric adenocarcinoma?
In general, we do not recommend adjuvant RT for T2N0 gastric adenocarcinomas unless other adverse factors were present. The long term results of the INT-0116 trial stated patients were T3-4 or node positive, but the initial report says stages IB-IV. Notably, the studied allowed T1N1 but not T2N0. Al...
Other than part of a clinical trial or for its FDA-approved indication (second-line therapy for metastatic squamous-cell NSCLC), when do you offer nivolumab to your patients with NSCLC?
How long do you continue maintenance chemotherapy for metastatic non-small cell lung cancer in patients who have achieved a radiographic CR?
This is a very difficult question. I think we need to keep in mind that less than 5% of all advanced stage non-small cell lung cancer patients acheive a CR with systemic chemotherapy. In addition, most of the maintenance studies published don't separate out CR and PR when discussing responses to the...
In light of CHAARTED and STAMPEDE, should all men with newly-diagnosed, treatment-naive metastatic prostate cancer be treated with chemohormonal therapy?
This is an evolving answer but presently I do offer 6 cycles of docetaxel to men with M1 (not N1) CSPC who are initiating or who have recently initiated ADT. This would include men who present with M1 disease but also men with rapidly recurrent mCSPC who are hormone naive. There appears to be a grea...
Should bone-directed agents, such as denosumab or zoledronic acid, be given when patients are being treated with radium-223?
In ALSYMPCA, bisphosphonate use at study entry was associated with a delay in symptomatic skeletal events (Sartor, et al. Lancet Oncol 2014; 15(7) 738-46). Based on this, osteoclast-targeted agents (i.e. zoledronic acid and denosumab) should be offered to patients with mCRPC that will receive radium...