Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
What are your top takeaways from ASCO GU 2025?
In terms of practice-informing presentations in prostate cancer here are my top 3: GROUQ-PCS 9 trial (Canada, abstract 22). This trial led by Niazi et al tested whether metastasis-directed radiotherapy based on conventional imaging to up to 5 sites provided benefits in delaying rPFS or PSA progressi...
For a patient with ICI toxicity who is resistant to the use of high-dose steroids, are there scenarios where you would consider the use of first-line conventional synthetic DMARD in place of steroids?
Loaded question — I think we need a reframing of ICI-toxicity, much of the ICI side effects are just an autoimmune reaction in a specific organ. High doses of steroids are used if there is a true risk for organ damage (like when you have acute ANCA vasculitis, lupus nephritis, etc.). So if a patient...
Would you ever consider adjuvant chemotherapy for a patient with rectal cancer treated with RAPIDO total neoadjuvant therapy after positive PNI was found on the surgery?
The patient should have received adequate systemic therapy per the RAPIDO trial; therefore, additional chemotherapy will not add any further benefit.
Does delay to the time of lumpectomy impact your decision to omit radiation?
There seem to be two issues to consider in this situation. One is whether patients undergoing neoadjuvant endocrine therapy, then lumpectomy without RT, have an acceptable local recurrence rate. The only study I know of directly addressing this issue was presented at a poster session of the 2017 San...
If an asymptomatic patient requires a delay up to a week before starting chemotherapy for Stage III lung cancer, do you also push back the radiation start date?
Typically, the reason for B12 and folate prior to chemotherapy is related to the drug that will be used, pemetrexed. Giving the premedication reduces hematologic and gastrointestinal toxicity to tolerable levels. One week typically will not make a difference and I would usually wait to start. Howeve...
How would you approach systemic treatment of oligometastatic recurrence following surgical removal of the single area of metastasis in a patient with ER+ (20-30%), PR-negative, HER2-negative breast cancer?
I would most likely start the patient on endocrine therapy and a CDK4/6 inhibitor. Even though the response rate is lower with this approach in patients with lower hormone receptor-positive breast cancer, it can still be a reasonable option, and it would avoid chemotherapy-related risks and toxiciti...
In which patients with stage 1 triple negative breast cancer would you utilize neoadjuvant chemotherapy?
Overall, neoadjuvant administration of chemotherapy is appropriate whenever adjuvant chemotherapy is indicated. There is clinical benefit from administering chemotherapy to cancers > 2cm because patients are often end up with smaller surgical resection than in the absence of neoadjuvant chemotherapy...
Should axillary imaging be routinely performed in all patients with a new diagnosis of breast cancer?
This issue has been debated but I would argue that patients with a new diagnosis of breast cancer should not undergo routine screening US of the axilla to look for clinically occult disease. The axillary US should be limited to diagnostic imaging for clinically suspicious nodes on clinical exam or b...
In which patients with atypical HUS would you consider eculizumab discontinuation?
My approach to eculizumab cessation in aHUS is to at least consider cessation in all patients not only given the high cost of the drug, but also given the risk of meningococcemia, which is incompletely protected against by vaccines.In treating aHUS, I initiate eculizumab (and preventive therapy for ...
In patients receiving adjuvant cemiplimab for high-risk cutaneous SCC, what is your standard surveillance strategy for detecting relapse?
Ultrasound (US), Computed Tomography (CT), Positron Emission Tomography (PET), and Magnetic Resonance Imaging (MRI) are all options for radiographic surveillance of patients at very high risk for cSCC disease relapse. Understanding the clinical presentation, tumor histology, and patient factors can ...