Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
What are your top takeaways in Classical Hematology from ASH 2025?
My top 3 takeaways in classical hematology:1) ITP - much controversy at the education program session about the draft 2025 guidelines, where TPO mimetic + steroids is going to be recommended in the front line. There does not appear to be compelling new data that supports the revision of this guideli...
Should other treatment options be considered for MALT lymphoma if the lacrimal gland will be included in the radiation field in a patient with Sjögren's disease?
The orbit is the second most common site of origin for extranodal marginal zone lymphoma (MZL). Involved orbital structures include the bulbar and/or palpebral conjunctiva, lacrimal gland, and periorbital soft tissues. Patients with Sjögren’s syndrome (SS) are at increased risk for developing extran...
Does the choice of radiation modality (3D, IMRT/VMAT, protons) impact the effectiveness of the reduced dose of 20 Gy in DLBCL?
I don’t think modality (IMRT vs 3D vs protons) has an impact on the effectiveness of the reduced dose of RT.
For biopsy proven extranodal marginal zone lymphoma involving two small bilateral lung nodules, would you consider definitive treatment to both nodules with radiation therapy?
It has been observed that many patients treated with radiation therapy for an extranodal MZL in a paired organ (orbital and parotid, in particular) will develop metachronous disease recurrence in the contralateral organ (Goda et al., PMID 20564130). In fact, it is relatively common for patients with...
For stage III-IV Hodgkin's lymphoma, would you consider consolidative radiation for bulky disease after a complete response was seen using N-AVD per the S1826 trial?
I would offer consolidative radiation only for PET-positive residual disease.
As consolidative thoracic radiation (cTRT) was prohibited on the seminal chemoimmunotherapy trials in ES-SCLC, how do you approach cTRT in practice?
There are two trials showing benefit for TRT for patients with ES-SCLC, one from Yugoslavia and one from the EORTC (though, the primary endpoint was not met). The Yugoslavian trial was not considered practice changing, while the EORTC study has made me consider adding TRT in certain patients, even w...
How would you approach a patient with recurrent grade 3 oligodendroglioma (MGMT-methylated, IDH mutant, 1p/19q co-deleted) 1 year after gross total resection and adjuvant chemotherapy and radiation?
There are multiple options to consider for the recurrence of grade 3 gliomas after prior chemotherapy or radiation. Regardless of whether or not the recurrence overlaps completely or partially with the prior treatment fields, options include systemic therapy (including IDH-targeted therapies for IDH...
What surveillance do you recommend for a patient with locally advanced rectal adenocarcinoma who had a complete clinical response to total neoadjuvant therapy and declines to undergo surgery?
It is important to watch these patients closely since ~15-20% will have local regrowth/recurrence that are salvageable (Dossa et al Lancet 2017). The OPRA trial, recently presented at ASCO 2020, included 324 patients treated with TNT regimens and WW if complete response. Organ preservation rates wer...
What initial systemic approach will you recommend for metastatic pMMR HER2- esophageal/GEJ/gastric adenocarcinoma with CPS of 0-4?
In such patients, OS does not differ between chemotherapy alone and chemotherapy plus immunotherapy, therefore chemotherapy alone would be an appropriate choice. There is no difference in terms of OS benefit between CPS <1% or CPS 1 to 4%. The benefit that immunotherapy adds to chemotherapy is sligh...
What high risk features for stage IB NSCLC would lead you to consider adjuvant chemotherapy?
Short answer is "no", I would not change practice based on the recently presented (ASCO) a non-randomized analysis of the potential benefits of adjuvant chemotherapy for patients with stage I NSCLC in Japan (Tsutani, et al. JCO 37(15S):457s, 2019; abst 8500). Many of these patients received UFT rath...