Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Do you consider NSCLC with multistation N2 involvement appropriate for treatment with neoadjuvant chemoimmunotherapy followed by surgery?
Interesting question and something that is frequently discussed in tumor boards. Multistation N2 patients were not included in neoadjuvant trials and hence, any adaptation of this strategy to patients with advanced N staging would not be appropriate at this time. Further, given level 1 evidence from...
Do you perform a bone marrow biopsy in all patients with grade 5 anaphylaxis to stinging insects and negative workup for HAT, MCAS, c-KIT?
Before saying that bone marrow biopsy is the next step (which it is), we must be certain that we are correctly assessing the situation. Was there documented hypotensive shock (and not just subjective light-headedness or brief vasovagal syncope? Were there other objective signs like urticaria (althou...
Is there a scenario in which you would consider observation for T4a SCC involving the mandible?
While PORT is well established, the scientific basis for it is relatively weak in the absence of a randomized trial, as all phase 3 trials have focused on adding something to radiation rather than the benefit of radiation alone. Further, the rationale for PORT historically is if there is a belief of...
What is the preferred neoadjuvant/adjuvant chemotherapy regimen for HPV-associated nasopharyngeal cancer?
Let me give more context: Had an interesting conversation with a med onc colleague regarding neoadjuvant or adjuvant gem/cis for HPV-associated NPC. I personally make a distinction between EBV-associated NPC and HPV-associated NPC. My interpretation of the data is that the benefit is only/mainly for...
For unresectable-appearing BRAF V600E papillary thyroid cancer involving the trachea and carotid artery, is neoadjuvant targeted therapy a viable path to surgery, or is definitive radiation the better option?
If the tumor is considered unresectable due to carotid encasement, as is likely in this case, then neoadjuvant targeted therapies should not be considered. Multikinase inhibitors (i.e., lenvatinib) or targeted therapies (dabrafenib and trametinib) will not produce great enough responses to make the ...
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What do you recommend for patients with stage 3 MSI-H colorectal cancer who are ineligible for oxaliplatin-based adjuvant therapy?
I typically don’t offer adjuvant therapy to those patients. 5-Fu/Xeloda does not benefit as a single agent in this patient population. If Oxaliplatin-based treatments cannot be given, then there are practically no other options that are associated with a survival benefit.
How do you approach treatment selection among novel bispecific antibodies and ADCs for patients with EGFR+ NSCLC previously treated with 3rd generation EGFR inhibitors?
I will focus the conversation here on metastatic NSCLC with EGFR exon 19 deletion or exon 21 L858R mutation. Patients with EGFR exon 20 insertion mutations are discussed in a separate question.The frontline therapy for our involved patient population is osimertinib single agent (less and less used w...
In light of the FLAURA2 data, which patients would you recommend upfront treatment with chemotherapy + osimertinib rather than osimertinib monotherapy?
The management of patients with advanced, classical (i.e., exon 19 deletion/L858R) EGFR mutation-positive NSCLC has been fairly straightforward since the approval of osimertinib for frontline management based on the outstanding results of the FLAURA study demonstrating significantly improved PFS and...
In what clinical scenario would you consider liver transplant evaluation for a patient with sickle cell hepatopathy?
I would do a concurrent stem cell transplant - in an effort to cure the underlying problem of sickle cell disease. Ideally, the same donor to prevent graft rejection.