Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Would you recommend completing adjuvant AC/pembrolizumab × 4 cycles before adding capecitabine, or proceeding directly with pembrolizumab plus capecitabine?
You can go either way here. However, since 6 cycles of docetaxel, carboplatin, and pembrolizumab are being compared to the entire KEYNOTE-522 regimen, I would lean towards proceeding with 6-8 cycles of capecitabine and continuing pembrolizumab to complete 1 year of treatment with this agent.
Has the POTOMAC trial changed how you approach BCG maintenance schedule in high-risk NMIBC?
Yes. If anything, these trials have reinforced for me how important it is to achieve adequate BCG maintenance in high-risk NMIBC. POTOMAC and CREST both used a two-year maintenance BCG backbone, with maintenance at months 3, 6, 12, 18, and 24, and both were positive trials. In POTOMAC specifically, ...
Would you continue serial PSMA PET scans after 2 negative scans for patients with a persistently rising PSA post-RT?
Some context would probably be helpful for this. E.g., PSA >2 is different for a patient post-prostatectomy vs. post-radiotherapy. But, in general, if clinical suspicion of cancer recurrence/progression is high, and PSMA PET is negative, one can consider the following options: There may not be a ca...
What would be your preferred treatment strategy for patients with NMIBC whose disease progresses after BCG plus durvalumab?
Pembrolizumab is little used in real-world practice in 2026. The response rates were lower than those of other more recently available therapies for BCG-unresponsive high-risk CIS, and the risk/benefit tradeoff is less favorable than other newly available treatments. Most urologists would treat pati...
How long do you continue trastuzumab and pertuzumab after lumpectomy if you included both in a neoadjuvant regimen such as TCH-P?
A total of one year for trastuzumab, including the part with chemotherapy, adjuvant or neoadjuvant. The benefit from addition of pertuzumab, as might have been predicted, was very small, since it is very hard to add any sizable benefit to trastuzumab without some logical risk stratification; for ER ...
Are CHEK2 mutations a contraindication for breast conservation therapy with lumpectomy + RT?
Among women with early-stage breast cancer and moderate penetrance breast cancer susceptibility genes, such as CHEK2, decisions about breast surgery are largely based upon personal preferences. According to data from large population-based studies, women with CHEK2 pathogenic variants have about a 2...
How would you approach a patient with HR+, HER2- metastatic breast cancer who is endocrine resistant, with bone marrow involvement and pancytopenia?
Symptomatic bone marrow involvement (bone marrow carcinomatosis) is extremely rare in metastatic breast cancer and carries very poor prognosis. It is often associated with microangiopathic hemolytic anemia and DIC. Anemia is the most common manifestation and WBC and platelet counts are often not tha...
Does the presence of cribiform histology at biopsy in prostate cancer affect your management in an otherwise intermediate-risk prostate cancer?
There have been no trials on this specific question, so there is room for debate and more science (hoping our recent grant submission in this area gets funded...). Here is my current thinking. This is for generally healthy patients with long life expectancy (≥10 years, but especially if ≥15 years). ...
When should you use single-fraction radiotherapy for spinal cord compression?
The SCORAD III trial is practice changing. But I do NOT plan to treat ALL patients with spinal cord compression with a single fraction of 8 Gy now. Here is why: SCORAD III is extremely important new study for the management of metastatic epidural spinal cord compression (MESCC) for patients with sho...
In light of GOG-252, are there any situations where IP chemotherapy would be preferable following debulking of advanced epithelial ovarian cancer?
In GOG-252, the control arm (arm 1) was the dose-dense Japanese GOG (JGOG) regimen, compared to two IP-based arms (arm 2, IP carboplatin, and arm 3, IP cisplatin). As stated in our OGR, interpretation of the negative results of this study is difficult for several reasons. All three arms in GOG-252 r...