Medical Oncology

Melanoma/Skin   

Questions discussed in this category



I am considering every 6 week pembrolizumab dosing in patients >70 years old in whom I want to reduce clinic visits for, especially in the context ...

A patient with stage 3 melanoma on adjuvant nivolumab needs radioactive iodine for papillary thyroid cancer.

Patient is a  67yo with a pT1 (2.5mm) pN1a merkel cell of the chest, 1 mm deep, widely clear margins, SLN with 1.5mm met, 11 additional axillary ...

Would you offer nodal dissection and/or additional adjuvant immunotherapy in addition to wide local excision?

For instance, not chronic autoimmune diseases (eg RA, IBD) that may relapse/remit but events like Guillan Barre syndrome that is not likely to recur b...

With increasing utility of immunotherapy across cancer types, patients with history of solid organ transplants may face need for cancer IO. How do you...

The FDA has approved the new dosing schedule of Nivolumab 480 mg every 4 weeks for multiple disease sites (melanoma, RCC, urothelial carcinoma, SCC of...

Do you recommend or withhold influenza and pneumonia vaccines while on treatment with checkpoint inhibitors?

The trials for adjuvant nivo, ipi and BRAF targeted therapy excluded patients with high risk stage 2. If no clinical trials are available, would you o...

Patients with T3aN1a( stage IIIA per AJCC7) were excluded from nivolumab adjuvant trial. Would you consider nivolumab in these patients?

Checkpoint inhibitors have demonstrated durable responses in clinical trials, which was never seen with cytotoxic chemotherapy in the past. What are t...

NCCN guidelines recommend both single agent Pembro and/or Ipi/Nivo as first line options. How would you choose between the two? In case of the latter,...

The FDA recently approved Braftovi (encorafenib) and Mektovi (binimetinib) in combination for unresectable or metastatic melanoma. When would they be ...

For example, would you consider this in a patient that would otherwise be eligible for adjuvant treatment (stage III or stage IV with oligometastatic ...

Can you extrapolate the data on Durable Complete Response After Discontinuation of Pembrolizumab in Patients With Metastatic Melanoma to patients on a...

In this study, doses of 2mg/kg Q3wks, 10mg/kg Q3wks and 10mg/kg Q2wks were used. What did the majority of these patients in CR receive? 

How do you treat these patients if they progress after immune checkpoint inhibitors?

Would your recommendation change at all depending on time to relapse or original stage of melanoma?

If staged so due to satellite lesion and negative nodes? How do you decide between adjuvant PD-1 inhibitor or BRAF/MEK inhibition in BRAF-mutated pati...

Assuming SRS to the resection cavity is advised, would you recommend early immunotherapy to improve outcomes/enhance a possible abscopal eff...

These patients have been largely excluded from these trials.  What if the infection is well controlled?

Would you ever considering re-starting immunotherapy before completing the taper? According to the new guildelines on managing immunotherapy related ...

Is the use of immunotherapy being considered, and if so, is the data extrapolated from treatment of mNSCLC and head and neck SCC?

Is there data for switching from nivolumab/ipilimumab to pembrolizumab if a patient develops significant pneumonitis but also had a significant radiog...

Can immune check point inhibitor be restarted if grade 4 hyperglycemia (with acidosis and insulin drip requirement) has resolved?

In a patient who already received 13 courses of radiation (with complete response), is there any other effective treatment?

Some medical oncologists tend to hold anticoagulation in patients who develop brain metastases for fear of causing intracranial hemorrhage.  Is t...

Would your recommendations change if it was a partial vs complete radiographic response?

What immunosuppressive agents are used and in what order?  Does your approach differ depending on the organ involved, e.g. colitis vs. pneumoniti...

Does the risk of severe inflammation of the liver lead you to choose other therapies in in this population?  What about in patients with mild liv...

Does the site of progression or response matter?  What if there is progression in the lungs but response in lymphadenopathy, for example?  

If these are presumed to be immune-mediated (e.g. immune neutropenia or immune thrombocytopenia), do you treat with steroids?

Is there any consensus regarding the optimal RT dose, fractionation, and timing to the best abscopal response? What is the optimal metastatic site to ...

Decrease the dose? Treatment break? Steroids?

With novel therapies quickly evolving, it's becoming more difficult to discern the proper sequence of therapies and the point at which a clinical tria...


Papers discussed in this category


Oral oncology, 2018-03

J. Clin. Oncol., 2018 Mar 14

Blood, 2015-07-23

Eur. J. Cancer, 2016-02-01

Immunotherapy, 2016-10

N Engl J Med, 2015 May 31

International journal of radiation oncology, biology, physics, 2016-06-01

The New England journal of medicine, 2017-11-09

N. Engl. J. Med., 2017-11-09

The Lancet. Oncology, 2016-11

The New England journal of medicine, 2017-10-05

Lancet (London, England), 2017-10-21

Lancet Oncol, 2018 May

The Lancet. Oncology, 2016-10

N Engl J Med, 2018 Apr 15

Lancet Oncol., 2017 Mar 04

Journal for immunotherapy of cancer, 2019-06-06

J. Clin. Oncol., 2019 Feb 27

Melanoma research, 2015-04

Nature, 2018-01-18

Cureus, 2019 Jun 18

Semin. Cancer Biol., 2019 Jul 19

J Natl Compr Canc Netw,

J. Clin. Oncol., 2019 Dec 27

Lancet (London, England), 2004-05-22

J. Clin. Oncol., 2019 Sep 25

Clin Oncol (R Coll Radiol),