Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Do you utilize consolidative radiation for metastatic NSCLC lung cancer patients on maintenance immunotherapy?
Yes but please refer these patients for NRG-LU002 study which is directly addressing this important question.
In what settings is Fluciclovine (Axumin) PET/CT best utilized in prostate cancer?
This is one of the key questions we'll have to deal with in prostate cancer, and I think it extends even past Fluciclovine. The development of the various modern molecular imaging modalities in prostate cancer has been an interesting phenomenon. In the U.S., Fluciclovine PET/CT was the first of the ...
How do you treat metastatic mesenchymal chondrosarcoma?
Mesenchymal chondrosarcoma is a rare aggressive variant of chondrosarcoma that is treated like a Ewing sarcoma. As with all chemotherapy, the patient's performance status should be acceptable to proceed with the chemotherapy which can be difficult to tolerate. If confirmed to be mesenchymal chondros...
How do you decide between adjuvant TDM-1 and trastuzumab in breast cancer patients who have residual disease at time of surgery but were unable to complete the recommended neoadjuvant course?
Since TDM1 is likely better tolerated than the standard neoadjuvant regimen, it would make sense to give adjuvant TDM1 if a patient had residual tumor following neoadjuvant chemotherapy that was discontinued early due to toxicity.
For patients with NSCLC with large primary tumors (ie T4) but no mediastinal nodal involvement who are found to have isolated oligometastatic disease in the brain, do you still consider definitive management of the primary lung tumor?
Interesting question! Particularly since T4N0M1 NSCLC is a relatively rare clinical scenario. First, what is the appropriate management of T4N0M0 lesions? Historically, these patients were considered unresectable and were classified as stage IIIB. Even with improvement in surgical techniques, resec...
When do you consider using high dose IL-2 in patients with mRCC?
There were patients in the earlier Ipi/nivo phase 2 experience who were IL-2 failures and responded to Ipi/nivo, raising the hypothesis that the mechanism of response is not entirely overlapping. Thus, I believe HD IL-2 could still have a role even with modern combos, but will be used sparingly give...
For a patient with unresectable EGFR positive lung adenocarcinoma treated with chemoradiation and a single site of oligometastasis treated definitively, would you consider durvalumab as per PACIFIC study or EGFR-directed therapy?
Technically, this is metastatic disease so I would do osimertinib here. I would avoid antiPD1 in known EGFR in metastatic setting due to pneumonitis risk when you have to start the EGFRi eventually
What is your preferred neoadjuvant chemotherapy course for healthy adult patients with osteosarcoma?
This article discusses the safety & efficacy of HDMTX in young adults and shows it can be safely administered, with good supportive care. The EURO-BOSS study is also a great resource for this topic.Because older adults do seem to tolerate HDMTX more poorly and experience markedly delayed clearance, ...
How many cycles of docetaxel do you give to patients with metastatic castration resistant prostate cancer?
Toxicity with Neuropathy can be a major problem in the elderly population.
Would you consider HRT in a young woman (<35 years old) with gBRCA mutated TNBC who underwent bilateral mastectomies and BSO?
I would use HRT for the beneficial effects of bone preservation, lipid improvement, sexual function, and quality of life. My preference is for women to have a concurrent hysterectomy with the BSO so the HRT can be estrogen alone, which has little, if any, risk for promoting breast cancer. In the les...