Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
What chemotherapy regimen is best suited for patients with platinum-refractory metastatic bladder cancer who have good or excellent performance status?
I would try to get patient to a pd1/pdl1 study or try to get it off-label. Early results are promising for 1/3 of patients.
At what point would Radium-223 dicholoride treatment be the best management for a patient with established metastatic prostate cancer with an elevated PSA and symptomatic bone pain with corresponding bone lesions on imaging?
At present, based on the randomised trial, it is approved for castrate resistant prostate cancer (can be chemo naive) with symptomatic bone only disease. In that situation, it improves all skeletal related events and survival and should be an indication to talk about this treatment. However, in prac...
Is there a role for post-treatment PET/CT following chemoRT for Stage III NSCLC?
The data from RTOG 0235 are certainly intriguing, but I don't think we have sufficient information to employ this in routine clinical practice.In fact, I think there are quite a few challenges, including, but not limited to:1. What is the true sensitivity for post-CRT PET/CT for LR failure? This was...
Do you ever recommend concurrent chemotherapy for high risk squamous cell skin cancer radiation?
Yes. The dose of radiation depends on the treatment scenario (adjuvant vs definitive). I generally follow NCCN guidelines, and give the same dose whether or not chemo is given. For bulky tumors, I might use a higher radiation dose if no chemotherapy is given. In general, the radiation dose is relat...
What is the optimal management of recurrent seminoma with small volume retroperitoneal disease initially managed with surveillance?
The question is how to manage pathologic confirmed CSII seminoma. If the nodal volume is on the larger side (> 3 or so cm), most experts would treat those patients with BEP X 3 with a very high cure rate, with very low likelihood of requiring any post-chemotherapy interventions. Most experts in the...
What is the role of radiation treatment of stage IA ALK negative anaplastic large cell lymphoma?
It would be helpful to know the site of origin. Most stage I ALCL alk neg would be in the skin, in which case RT is the treatment of choice with little role for chemotherapy. Stage I ALCL, other then skin, would be quite rare with no data to guide us, except that we know response to chemotherapy for...
How do you approach the treatment of uT1N0M0 gastric cancer if the EUS is consistent with linitis plastica?
Linitis plástica means that the entire stomach is involved with cancer therefore treatment would be mainly palliative with systemic chemotherapy for stage IV disease
What is your approach to patients with stage III melanoma now that the FDA has approved adjuvant ipilimumab for high risk stage III melanoma patients?
The newly approved ipilimumab high-dose adjuvant modality needs to be presented to patients with stage III disease in the upper risk categories for which the trial showed reduction in relapse risk at analysis 18 months ago, as presented to ASCO 2014 and subsequently published. Unfortunately, there i...
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...