Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Do you consider MSI testing for mCRPC?
I agree that data for response to immunotherapy in MMR-deficient (dMMR) prostate cancer is limited, and we estimate the rate of dMMR in prostate cancer to be low, in the 2-3% range. Nonetheless, based on responses in other dMMR tumors, pembrolizumab is now FDA approved for all dMMR/MSI-high unresect...
Would you hold immunotherapy if a patient with metastatic melanoma has stable disease for 6 months?
We would usually not stop therapy in a patient with a stable disease as best response after only 6 months. In Keynote 006, patients had to stop therapy after 2 years of treatment. In this trial, 12 patients were in stable disease after 2 years. Ten of them were still in stable disease after 9 months...
Do you recommend a workup for POEMS and/or amyloidosis for IgM monoclonal gammopathies associated with neuropathy?
While IgM monoclonal disorders, amyloidosis, and POEMS syndrome may all be associated with peripheral neuropathy, they are not often confused with one another. A patient with a peripheral neuropathy can be diagnosed most simply by a serum protein electrophoresis. The presence of a monoclonal IgM spi...
Do you recommend a workup for POEMS and/or amyloidosis for IgM monoclonal gammopathies associated with neuropathy?
While IgM monoclonal disorders, amyloidosis, and POEMS syndrome may all be associated with peripheral neuropathy, they are not often confused with one another. A patient with a peripheral neuropathy can be diagnosed most simply by a serum protein electrophoresis. The presence of a monoclonal IgM spi...
How do you decide how many sites to treat with SBRT in a patient with metastatic Ewing sarcoma?
In patients with 5 or fewer metastatic sites, it is a very reasonable approach to be comprehensive and treat the primary (if required) while saving the metastatic sites until the end of treatment. When more than 5 sites require treatment, I prioritize metastatic sites that have not had a complete re...
Do you recommend ovarian suppression in all premenopausal women under age 35 with ER positive breast cancer based on the SOFT/TEXT data, regardless of other risk features?
I do not recommend ovarian suppression on all women under 35. Like any intervention, we need to know the absolute risks of recurrence with and without the intervention. For these reasons, given the side effect profile of ovarian suppression in younger women, I usually reserve it for women with large...
How has COVID-19 altered your recommendations for invasive mediastinal staging for NSCLC?
I just had this discussion with our chief of interventional pulmonolgy at MD Anderson. Some of his faculty are being asked to staff our COVID-19 patient floor. In addition, bronchoscopy procedures should be considered high-risk procedures, and are required to have at least 45 minutes in between proc...
What are the current official guidelines regarding managing patients during COVID-19?
Here are some guidelines and FAQ from professional societies: NCCN: https://www.nccn.org/covid-19/default.aspx ASTRO FAQ: https://www.astro.org/Daily-Practice/COVID-19-Recommendations-and-Information/COVID-19-FAQs ASCO Coronavirus Resources: https://www.asco.org/asco-coronavirus-information
What are best practices for taking care of lung cancer patients during the COVID-19 pandemic?
This is a great question, and as always there is no one size fits all. For patients on active treatment for lung cancer such as chemoimmunotherapy, I continue to stress the importance of hand washing, social distancing, and to work on reducing wait times in the waiting room to limit exposure, etc. I...
How will your management of head and neck cancers change with the COVID-19 pandemic?
Short answer: Most head and neck cancer radiation is as necessary as it gets. At this point, my management won't change very much. That may change as the pandemic evolves. Use all the appropriate precautions to stop the spread of COVID-19 and other viruses (we are using masks for every staff member,...