Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
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?
DAHANCA 5 trial and combined analysis from DAHANCA 5 and 7 showed no benefit to transfusion, so only if symptomatic or other clinical consideration.
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...
For a patient with inflammatory breast cancer after standard initial systemic therapy with only a partial response, do you recommend more systemic therapy, pre-operative radiation, or proceed to modified radical mastectomy?
The systemic therapy question was addressed and partly answered with the CreateX trial. In that 900 patient trial there was an improvement in DFS and OS with adjuvant capecitabine. The current EA1131 explores this question further, directly comparing cape to platinum. The randomization is stratified...
Should FISH studies be repeated when CLL patients under active surveillance have progressive disease warranting treatment?
FISH studies should be performed on a newly diagnosed patient with CLL as well as those who have progressive disease and now warrant additional therapy. It is important to identify those patients who may have acquired additional cytogenetic abnormalities due to clonal evolution/resistance/etc as thi...