Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Is fetal monitoring recommended when administrating IV iron to a pregnant patient?
There is no evidence of fetal harm with IV iron, and recommending this is inconvenient and unnecessary, and it does harm as it discourages necessary care. Two guideline papers, Van Doren et al., PMID 38282557, and Benson et al., PMID 40306833, as well as Anemia in Pregnancy in UpToDate, support this...
Do you discontinue an aromatase inhibitor in a patient if they have a cardiac event while on the drug?
Randomized clinical trials and several meta-analyses that compared tamoxifen with aromatase inhibitors (Khosrow-Khavar et al., PMID 32065766 is a more recent one) demonstrated statistically significant increase in the rate of cardiovascular events in women taking aromatase inhibitors although the ab...
How would you approach the management of a patient with metastatic non‑small cell lung cancer who previously received whole brain radiation therapy three years ago and now presents with 20 new brain metastases on MRI?
How aggressive I would be depends on KPS (which sounds to be good in this case), the patient's extracranial disease status (which sounds to be controlled on current therapy in this case), plans from a systemic therapy perspective (will the patient continue on the same therapy and what was the patien...
For a patient with metastatic colon cancer who tested positive for MSI (i.e. MLH1 hypermethylation etc) and BRAF mutation, what would be your preferred choice in the second line setting?
Approximately 15% of colorectal carcinomas demonstrate mismatch repair deficiency. The majority of these are MLH1/PMS2 deficient due to MLH1 promoter hypermethylation (MLH1ph). BRAF V600E mutations occur in approximately 50% of colorectal carcinomas with MLH1ph. The role of immunotherapy in patients...
Would you withhold immunotherapy for ES-SCLC during the COVID-19 pandemic?
Risks of COVID-19 infection and severe pneumonia seem to be higher in our patients with lung cancer. This is fairly early data and some of the patients included in those analyses were not receiving any active therapy. This suggests that at least some of the risk is simply frequent visits to the canc...
When, if ever, would you recommend risk reducing BSO in patients with moderate penetrance breast cancer germline mutations?
RAD51C, RAD51D, and BRIP1 are all associated with significant risks of ovarian cancer and are appropriate for consideration of prophylactic oophorectomy, albeit perhaps at a slightly later age than BRCA1 and BRCA2. ATM and PALB2 may be associated with ovarian cancer risks that are similar to that of...
Are you using tarlatamab for neuroendocrine carcinomas (NECs) and poorly differentiated neuroendocrine tumors of GI (non-lung) origins?
We have treated a few patients with DLL3+ extrapulmonary NECs (epNECs) with tarlatamab, but we have not reported our experience yet. There have been responses, but mostly short-lived, but I know of cases where the responses were more durable than one would expect in epNECs progressing on first-line ...
Would you offer adjuvant therapy for patients with resected NSCLC <3 cm with visceral pleural involvement and no lymph node involvement?
The short answer is "no", I do not typically recommend adjuvant systemic therapy or radiotherapy for people with completely resected, small (<3 cm) T2aN0M0, stage IIA NSCLC.The NCCN guidelines state that "adjuvant chemotherapy is recommended for high-risk features" in people with resected stage IB o...
Do you offer adjuvant therapy for localized medullary carcinoma of the ascending colon that is MSI-H?
Medullary carcinoma of the colon is a rare type of colon cancer with unique clinical and molecular features. Despite its high-grade histology, its prognosis is generally better than adenocarcinoma. They tend to be locally advanced and rarely metastasize. They are usually MSI-H with a high number of ...
Would you recommend discontinuing testosterone replacement in a male patient in his 60s with newly diagnosed favorable intermediate-risk prostate cancer who is declining surgery and will receive definitive radiation?
Historically, we (as a field) have viewed TRT as the opposite of ADT and therefore inherently problematic. I am not convinced this is logical. ADT has RCT evidence to support it, whereas withdrawing TRT has not been as cleanly studied. Let's say we stop TRT, and this drops their testosterone to 150 ...