Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
When determining treatment approach to newly-diagnosed follicular lymphoma (e.g. watchful waiting vs chemotherapy), do you take the intensity of the SUV measurements on PET into account?
The short answer is NO. The SUV value does not inform the decision between a "watch and wait" vs. chemotherapy approach. Overreliance on SUV values in newly diagnosed follicular lymphoma is not recommended. The intensity of SUV measurement may, however, aid in locating a site for biopsy. For example...
How do you approach prostate cancer patients with persistent obstructive lower urinary tract symptoms after primary radiation therapy?
If the persistent LUTS is due to radiation treatment, and medical therapy is not sufficient -- then I would refer the patient to urology for consideration of a channel TURP. Patients with metastatic cancer can have local (prostate) disease progression and experience significant obstructive symptoms ...
Is CA 27-29 helpful in surveillance of patients with Stage I-III breast cancer in remission?
There is not really any data supporting the use of surveillance tumor markers in breast cancer and is discouraged in ASCO guidelines. In known metastatic patients, I will check both CA 15-3 and CA 27-29.
How do you treat a patient with synchronous locally advanced lung and head and neck cancers?
This is obviously a very difficult and challenging clinical situation. Most people have a very difficult time undergoing simultaneous treatment to both areas. Typically, I have started with induction systemic therapy. This is especially useful for larynx and hypopharynx cancer patients. This provide...
When do you use neoadjuvant endocrine therapy for postmenopausal women with ER positive early stage breast cancer?
I think that neo-adjuvant endocrine therapy is an excellent option particularly for post-menopausal women with strongly ER/PR + cancers who are marginal candidates for breast conservation. I will generally consider for those women who don't have any characteristics that I think would require chemoth...
How do you approach subsequent treatment in patients with unresectable hepatocellular carcinoma who have progressed on first line sorafenib?
For patients with widespread bony metastases from prostate cancer, do you ever consider treating with beta-emitters such as Samarium-153 or Strontium-89 over Radium-223?
I use radium 223 in all patients unless thier performance staus is poor ECOG-2 or they have significant visceral disease. In those cases it may difficult to get authorization for Radium 223. In terms Cost effectiveness there is data now from the ALSYMPCA trial updates that patient's who received Rad...
Is there any role for re-challenge with enzalutamide or abiraterone after prior failure in metastatic castrate-resistant prostate cancer?
Returning to a therapy on which a patient with mCRPC had previously progressed can be done with docetaxel (Bracarda et al, Future Oncol. 2015;11(22):3083-90; Di Lorenzo et al, Medicine (Baltimore). 2016;95(14):e2754), where a patient may derive clinical benefit to a re-challenge. Typically, the pati...
How do you approach a patient with Stage I node negative ER+ invasive ductal carcinoma s/p lumpectomy who has an intermediate Oncotype?
Intermdiate scores always require a long discussion with the patient - this is definitely a case with no one answer. The potential benefit of ANY chemotherapy is quite small. Some patients may accept chemo for that small benefit, others easily defer. I haven't used AC alone in many years. When I do ...
How do you decide on the modality of consolidative treatment after a CR in primary CNS lymphoma patients treated with a high-dose methotrexate regimen?
Unless there are contraindications to autologous transplant I favor consolidation with autologous transplant. The long term complications of whole brain XRT include significant neurocognitive deficits. These approaches are rough equal with regards to efficacy.