Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Would you treat a patient with non-clear cell renal cell carcinoma with nivolumab and ipilimumab?
What is your approach to patients with unresectable, node-negative perihilar cholangiocarcinoma who have undergone biliary stenting and have no evidence of distant disease?
For perihilar cholangiocarcinoma that has been deemed unresectable by hepatobiliary surgeons, a good consideration is to have the patient evaluated for liver transplantation. The Mayo Clinic protocol allows tumor mass of <3cm, no nodal disease, and vascular involvement is allowed. Depending on the f...
How does the updated classification system of gliomas impact your recommendations for radiation?
Minesh Mehta and @Dr. First Last, Miami Cancer Institute In 2021, the World Health Organization (WHO) introduced significant new changes to the classification of tumors of the central nervous system (CNS) in their 5th edition (WHO CNS5) (Louis et al., PMID 34185076). This step was the first of many ...
For metastatic prostate cancer, when would you add carboplatin to docetaxel or cabazitaxel?
There is no clear consensus on this topic. However, I consider carboplatin plus docetaxel or cabazitaxel in men with the following features who are fit for chemotherapy and wish to be aggressive in their care, based on Paul Corn's MD Anderson trial (PMID 31515154): Aggressive variant phenotypic feat...
For patients with mild CKD, how do you decide between zoledronic acid and denosumab for bone protection in patients with multiple myeloma?
In this scenario, I prefer zoledronic acid every 3 months with renally adjusted dose. In my experience, the risk of hypocalcemia seems higher with denosumab. Calcium/vitamin D supplementation would be important as well. The every 3 month dosing is an advantage over denosumab, which would have to be ...
How do you approach adjuvant comprehensive breast or chest wall RT for locally advanced breast cancer on a CDK 4/6 inhibitor?
Prospective data in this setting is limited. Retrospective and preclinical data with palliative RT and CDK 4/6 inhibitors have shown mixed results, with some showing skin and lung toxicities and others not. Adjuvant trials allowed concomitant use, but have not reported separately. My bias for PMRT i...
How do you manage drug-induced thrombocytopenia when the implicated drug is essential?
I feel obliged to answer this one as a question of medical sociology as much as a direct medical question, because "essentialness" is nearly always in the eye of the beholder, and I have not personally been in the position of the hematologist who has to confront this question with an interventional ...
Do you routinely obtain CPS assay to assess candidacy for chemoimmunotherapy in newly diagnosed metastatic esophageal/GEJ/gastric adenocarcinoma?
I am still apt to assess tumor PD-L1 CPS to help inform long-term benefit from first-line chemoimmunotherapy in a patient with metastatic disease. Intrapatient, interlesional heterogeneity for PD-L1 CPS has also been recognized in the literature corresponding to discordance in levels of PD-L1 CPS po...
In the modern era, what is the role of beta-emitting bone-targeted radiopharmaceutical therapy?
Since the approval of Radium-223 dichloride (Xofigo), I have been using it as the preferred radiopharmaceutical for patients with mCRPC. While use of Samarium-153 and Strontium-89 improves pain control, Radium-223 is an alpha-emitter and is the only FDA approved radiopharmaceutical that has been sho...