Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Do you recommend GLP-1 agonists in patients with MPN?
I don't think that there is a compelling reason to start a GLP-1 agonist without another indication. With that said, there was a provocative recent abstract at SOHO suggesting a significant reduction in mortality, thrombosis, and disease progression in GLP-1-treated PV patients compared to those who...
Would you offer tarlatamab to patients with metastatic EGFR+ NSCLC that transformed into SCLC?
Yes, in fact, we recently collaborated on a multi-institutional report of a small cohort of such patients and have tried it a few additional times since then for patients with EGFR (or ALK) transformed into SCLC. We have seen a few exceptional responders, suggesting there's a potential role for it, ...
Would you offer cisplatin concurrent with radiation to a patient with p53-mutated stage III endometrial cancer if she has adult-onset hearing loss and uses a cochlear implant?
Cisplatin is commonly used for radiosensitization in patients being treated for gynecologic cancer. Ototoxicity is a common side effect of cisplatin. It is caused by the death of outer hair cells in the inner ear. Cochlear implants are used to treat hearing loss in patients with severe hearing loss ...
Do you recommend prostate RT for patients with metastatic (M1) disease?
My short answer to this provocative question is “no, I don’t offer men with M1 disease local radiation unless there’s a palliative need.” Treating the primary in the asymptomatic M1 scenario, whether with RT or with surgery, is a major commitment of time, resources, and risk to the patient. The leve...
Would you choose neoadjuvant endocrine therapy for a low grade, node negative, ER/PR positive, breast cancer given delays in definitive surgery due to the COVID-19 pandemic?
We have been offering NAE to patients with lower grade, lower Ki-67% and strongly ER/PR+ breast cancers. The selection of NAE vs primary surgery is typically being determined on the basis of patient age and co-morbidity (e.g. the greater we believe the patient's risk from contact with the healthcare...
What treatments, after appropriate dose reductions/delays, do you offer for patients with oxaliplatin-induced cold allodynia/dysesthesia?
The primary treatments that I use for cold-induced oxaliplatin neurotoxicity are reducing the oxaliplatin dose and limiting the duration of oxaliplatin treatment (usually not more than 16 weeks of oxaliplatin-containing therapy in the initial line of treatment). Medications that are effective for pa...
How, if at all, will you incorporate durvalumab + FLOT in patients with HER2+ resectable gastric/GEJ adenocarcinoma?
Currently, there are no approved biomarker-driven targeted therapies for patients with locally advanced resectable gastric/GEJ adenocarcinoma. While data from the metastatic setting have consistently demonstrated improved outcomes with the addition of HER2-targeted therapies to chemotherapy in HER2-...
How would you treat a high intermediate risk stage IA grade 2 endometrial ca?
If it is Stage IA, Grade 2 without additional risk factors, we recommend observation. It is not considered high intermediate risk.If it is Stage IA, Grade 2 with additional risk factors such as LVI or age 60+, we recommend a referral to radiation oncology to discuss. Anecdotally, most patients will ...
What normal tissue constraints do you use, if any, in patients receiving vaginal cuff brachytherapy alone?
We optimize based on the PORTEC 2 and PORTEC 4 protocol recommendations. We use CT-simulation and 5mm optimization points. There are no normal tissue constraints when using this approach and 2D planning can be utilized. We do not insert, for example, bladder points. Many planning studies have demons...
Would you consider chemoradiation + chemotherapy as in PORTEC-3 regimen for p53 mutated stage IA endometrial cancer, though this trial did not include those with stage IA disease?
There are not sufficient data to recommend this regimen in patients with stage IA endometrioid endometrial cancer. In subset analysis of patients with grade 3 endometrioid cancer with + LVSI, there was no difference in recurrence free or overall survival (OS) with the addition of chemotherapy. For p...