Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Do you routinely recommend consolidative radiation to bulky site(s) in the setting of advanced stage DLBCL?
How radiation therapy (RT) should be incorporated into the management of patients with advanced DLBCL continues to be investigated. In the setting of widespread, non-bulky disease, when a complete response is achieved with systemic therapy, I don't recommend consolidation RT. Though controversial, I...
How do you manage adjuvant endocrine therapy for pre-menopausal women with locally advanced, weakly positive ER/PR, HER2 negative breast cancer?
Likely very little benefit. Reasonable to try tamoxifen if tolerated.
For patients with a history of pregnancy loss, do you evaluate for PAI-1 polymorphisms as part of a thrombophilia workup?
I do not.The relationship between PAI-1 polymorphisms and thrombosis is complicated, and general guidance suggests against assessing for PAI-1 overexpression as part of a thrombophilia workup. While there is some data to suggest an association between PAI-1 polymorphisms and pregnancy loss, ALIFE2 s...
Would you consider prophylactic anticoagulation for May-Thurner syndrome in pregnancy if prior endovascular intervention has been completed?
In general, I have a very low threshold to initiate prophylactic anticoagulation in pregnancy. For a patient with a history of May-Thurner that has been endovascularly corrected and who has been maintained off of anticoagulation without issue, I would have a risk-benefit discussion about prophylacti...
What is your approach to consolidation for localized small cell bladder cancer after neoadjuvant cisplatin and etoposide?
There is limited data with regard to the best management of these patients. Most data is retrospective and has an inherent bias. That being said, there seems to be a benefit for surgical resection after NAC (Patel et al., 24036236), with RT a consideration if surgery is not an option. In a small ser...
Will you offer durva-FLOT perioperatively for adenocarcinoma of the esophagus?
Yes, especially distal or GEJ.
What factors do you take into account when deciding the length of adjuvant temozolamide in GBM?
The field is evolving from 12 cycles to 6 for IDH-wildtype GBM in recent years, on the basis of some retrospective studies and notably the prospective Spanish study GEINO 14-01 - there does not seem to be much OS benefit, and there are also toxicity concerns (myelosuppression, hypermutation). Extens...
What treatment sequence do you follow for patients with rectal cancer who are candidates for both PROSPECT and TNT/Watch and wait?
Thanks for this question. I am not sure whether this is up to us. This is up to our patients to choose which modality they would like to omit (radiation vs surgery). I would point out that a good quality MRI rectum should be performed to r/o any T4/N2 disease or potential requirement for APR. Otherw...
In what clinical scenarios, if any, would you consider using sacituzumab govitecan prior to trastuzumab deruxtecan for HR+/HER2- metastatic breast cancer treatment?
The ASCENT-07 trial did not meet the primary endpoint of superior PFS for 1st-line SG vs standard chemotherapy (taxane or capecitabine) in ER+ HER2- mBC. OS readout was immature with an early trend in favor of SG that needs follow-up. However, SG was still active with longer durations of responses. ...
Would you continue cemiplimab adjuvantly, following resection of initially unresectable cutaneous squamous cell carcinoma treated with downstaging immunotherapy?
This is a challenging question because, as you know, we have no randomized data to address it. I generally do not continue immune checkpoint therapy after resection of SCC skin. However, given the adjuvant data in melanoma and the high efficacy of anti-PD1 in skin SCC, I do think it is reasonable to...