Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How would you manage a patient with surgically resected T3N1 NSCLC who is found to have one small brain metastasis on staging MRI?
For adjuvant chemotherapy, this is a difficult question for which there is no evidence-based answer, really. The "textbook" answer is that this is metastatic disease, and adjuvant therapy has only been proven for early stage disease. However, since there is still a reasonable chance of a cure after ...
Is there any data to support to use of Brentuximab in the up-front setting in the treatment of Hodgkin lymphomas?
Currently, Brentuximab vedotin is only approved in Hodgkin lymphoma 1) following failure of 2 multi-agent regimens or ASCT and 2) for post-ASCT maintenance. However, there are several ongoing phase II and III trials in both the US and EU examining Brentuximab vedotin in the up-front setting. The lar...
When do you offer consolidation chemotherapy for patients receiving chemoradiation for locally advanced NSCLC?
I rarely use consolidation therapy. When I do, it is usually because of lapses in or missed chemoRT treatments. We have two randomized studies that show no benefit to consolidation therapy.
In patients with metastatic NSCLC, would you consider atezolizumab after failure of nivolumab or pembrolizumab?
Do you ever withhold PCI for elderly patients with limited stage SCLC?
In my opinion, the findings by Takahashi et al, Lancet 2017 regarding the lack of survival benefit of PCI as compared to MRI observation in patients with extensive SCLC has re-opened the question of the survival benefit of PCI in limited SCLC in the modern imaging era. Hopefully, a phase III study o...
When TPN is a barrier to enrollment in hospice for an eligible cancer patient with an irreversible malignant bowel obstruction, how do you approach the conversation about discontinuation of TPN?
This is such a tough question with no great answer. With any difficult conversation like this, I usually take this approach: 1) Understand what the patient's goals are. ("What's most important to you?") 2) Usually they say living as long as possible/as well as possible 3) Acknowledge that goal as r...
How would you treat anal cancer in a patient with non-dialysis dependent severe chronic kidney disease that precludes the use of cisplatin?
How would you approach definitive nonsurgical management for biopsy-proven, localized small cell carcinoma of the prostate?
Rare disease and one patient we treated with cis plus etoposide with RT added with second cycle. Because of concern about unsampled mixed high grade histology we planned to treat to 70 Gy. No PCI as isolated brain relapse for pelvic small cell is not same as for small cell of lung
How would you treat a patient with widely metastatic clear cell RCC who has undergone craniotomy/resection of a single brain metastasis?
Initial therapy in the front line setting for a person with widel metastatic disease would include either sunitinib or pazopanib. I would not use IL2 in this setting because of the recent brain surgery. Clinical trials should also be considered,
How do you manage a patient who has developed a symptomatic pleural effusion while on dasatinib?
A variety of approaches to dasatinib-induced pleural effusion are possible. It is common to rechallenge the patient with dasatinib once the effusion resolves. You can rechallenge with the standard dose if the grade of the initial effusion was grade 1 or 2 (by CTAE grading) or at 50 mg if the effusio...