Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
What is your approach to cancer patients who inquire about alternative or complementary treatments?
It depends a little bit on what specifically they want to use, and if they are truly investigating alternative medicine or complementary medicine. For people seeking full alternative medicine without any conventional treatment, I tell them that a research study showed that people who pursued the alt...
What is your approach to cancer patients who inquire about alternative or complementary treatments?
It depends a little bit on what specifically they want to use, and if they are truly investigating alternative medicine or complementary medicine. For people seeking full alternative medicine without any conventional treatment, I tell them that a research study showed that people who pursued the alt...
Is there any outpatient protocol for cisplatin/doxorubicin neoadjuvant chemotherapy for osteosarcoma?
Not really. The full dose of cisplatin (120 mg/m²) is difficult (not to mention cruel) to deliver as an outpatient, given the need for fluids, antiemetics, and supportive care.
Would you extend pembrolizumab for over 2 years in a patient with MSI-H pancreatic ductal adenocarcinoma with now-stable disease?
I usually don't, but admittedly, this is a "data-free zone" in the pancreas. I would just stop and watch carefully with scans and tumor markers and have a low threshold to resume or biopsy if it looks like there is progression.
How do you monitor for cardiac toxicity in patients taking osimertinib?
There are multiple studies that have explored the issue of cardiotoxicity from osimertinib. A large single-center retrospective observational cohort series from Taiwan, (n=401) compared a matched cohort of patients treated with osimertinib (n=253) to those treated with other EGFR TKIs (n=195) and fo...
When would you consider Amivantamab + Lazertinib combo for first line in EGFR mutated metastatic NSCLC?
I would certainly consider amivantamab + lazertinib combination treatment in the first-line setting for metastatic EGFR-mutated NSCLC. This is based on the data from the MARIPOSA phase III trial. This trial noted improved survival outcomes in the frontline setting for patients with EGFR exon 19 dele...
What guides your choice between prophylactic, intermediate, and full therapeutic dosing of enoxaparin in a woman with APLS and prior fetal loss with no hx of thromboembolic disease?
First, it is essential to confirm that patients meet criteria for obstetric antiphospholipid antibody syndrome (OAPS), based on the 2023 ACR/EULAR classification criteria. This includes persistently positive laboratory criteria (confirmed on repeat testing >12 weeks apart), plus otherwise unexplaine...
What systemic therapy would you use in T3N1M1 MMR proficient rectal cancer with solitary liver lesion when going for curative intent (chemo>short course RT> resection of primary and liver met)?
Hi,I think this is an important question. For resectable disease, most data we have is from the EORTC 40983 trial in which FOLFOX was used. For borderline resectable, you could consider FOLFOXIRI based on the OLIVIA trial. That being said, obtaining molecular profiling for this patient is key which ...
Would you consider using ensartinib in patients with ALK-positive NSCLC who have progressed on alectinib and lorlatinib?
I've written about this previously (https://www.themednet.org/question/23471). The question invokes a conceptual model of cancer therapy sequencing from the chemotherapy era, where it was the norm to go through lines of therapy with diminishing returns (e.g., platinum doublet, then docetaxel, then g...
In patients with T1 anal squamous cell cancer status post local excision with a close margin, would you recommend close observation or adjuvant concurrent chemoradiation?
I would solicit the opinions of my colorectal surgery and GI colleagues to see if re-resection (with TAMIS, for example) is possible. If it is not, I would likely observe. If the margin was positive and not just close, I would do traditional chemoradiation.