Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Will you consider additional capecitabine in a patient with TNBC, residual disease after neo-adjuvant chemo, before getting adjuvant pembrolizumab or placebo on SWOG 1418 clinical trial?
We offered adjuvant capecitabine to our TNBC patients with residual disease after neoadjuvant chemo prior to enrolling them on our adjuvant immunotherapy clinical trials.
How soon after ChemoRT for a head and neck cancer can you safely initiate esophageal dilation?
Interesting, I think that we saw fewer before gastrostomy tubes and whole neck IMRT
How do you manage androgen deprivation in a patient with oligometastatic prostate cancer in which the primary and all known metastatic sites have been treated with curative intent radiation and PSA remains undetectable?
A great question and one that we don't have data for yet! In the absence of data, we can fall back on what we know about prostate cancer and its response to radiation and hormonal therapy, and remember the goals of treatment. Studies in the localized setting combine ADT with RT for 3-26 mo, with len...
Do you offer induction chemotherapy for patients with cT4N0 laryngeal cancer who decline surgery and are not candidates for high dose cisplatin-based concurrent RT?
any curative intent treatment with cisplatin would be high dose. are they not candidates for cisplatin or RT? If renal issues and not candidates for cisplatin, would go with carbo/taxol or cetuximab with definitve RT If not candidate for RT, would go with palliative intent chemo+immunotherapy
Are there any histologic subtypes of ER+, HER2- breast cancer that you would omit adjuvant endocrine in?
I agree that low grade, stage I, 'rare, less aggressive' histology has a great prognosis vis-a-vis distant metastasis. But, my decision on adjuvant endocrine therapy will not be based on just the histologic subtype. In other words, I would factor in traditional prognostic factors in deciding therape...
How long do you continue surveillance imaging for NSCLC after definitive treatment?
Theoretically, many of these patients would likely have the risk factors to qualify for ongoing low dose CT chest surveillance well after addressing their pulmonary malignancy.https://www.ncbi.nlm.nih.gov/pubmed/21714641
In deciding between 3 versus 6 months of adjuvant therapy for colon cancer, how would you factor in the presence of isolated tumor deposits (staged as N1c), but negative lymph nodes?
My approach to N1 and N1c is exactly the same. For T4 N1/N1c disease, I offer 6 months of adjuvant FOLFOX or CAPOX. For T1-3 N1/N1c disease, I favor 3 months of adjuvant chemotherapy with CAPOX as the preferred regimen.
Is there a lung metastasis size cut-off do you suggest for selecting between BEP and VIP as initial chemotherapy in advanced testicular cancer?
I do not use a size cut off to select initial chemotherapy regimen for advanced testicular cancer. I rather use the International Germ Cell Cancer Collaborative Group (IGCCCG) model for initial risk stratification. Irrespective of risks, BEP is considered standard initial regimen. Nevertheless, for ...
How would you treat a patient with small cell ca of the appendix with no evidence of distant mets?
Small cell carcinomas of the appendix are exceedingly rare and one has to question if that truly is the origin of the tumor. High-grade neuroendocrine carcinoma, including both small-cell and large-cell, is much more commonly seen in the large bowel, often in the cecum.There are extremely limited da...
In patients with metastatic RCC who have had a complete response to pembrolizumab and axitinib and undergone a nephrectomy, how long would you continue therapy post-operatively?
This is a great question and increasingly relevant. The larger question is about duration of IO-based therapy in general, especially when patients are at maximal response (CR or deep and stable PRs). The honest answer is that nobody knows. My sense is that the decision is based on pt preference and ...