Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
What are your top takeaways in GI Cancers from ASCO 2025?
ATOMIC - adding atezolizumab checkpoint inhibitor for 1 year to 6 months of adjuvant FOLFOX is the new standard of care for MSI-High stage III colon cancer. MATTERHORN trial - adding durvalumab to perioperative FLOT in resectable gastric adenocarcinoma significantly improved event-free survival...
Would you offer gemcitabine/cisplatin (or other platinum-based regimens) for metastatic pancreatic cancer harboring somatic ATM mutations?
Yes, potential sensitivity to DNA-damaging agents.
What is the best supportive care for lacrimation/rhinorrhea with pemetrexed for lung cancer?
Antineoplastics drugs, such as pemetrexed, can damage the epithelial cells of the conjunctival mucosa. Inflammation and fibrosis of epithelial cells of the lacrimal duct following systemic chemotherapy may lead to lacrimal outflow obstruction and epiphora. The mechanism of lacrimation caused by trea...
Would you offer adjuvant chemotherapy to a premenopausal woman with HR+ HER2 negative IDC, T1cN0, with isolated tumor cells, oncotype RS 20, grade 2, with multifocal LVI?
First - isolated tumor cells have no clear impact on prognosis and should NOT be used to alter local or systemic treatment decisions. The TAILORx trial unplanned subgroup suggested a small but real benefit from chemo. However, very few (11%) of premenopausal patients got optimal HRT that included OF...
How do you manage newly diagnosed multiple myeloma patients who have a contraindication to steroids?
This is a rather rare situation, but it can happen. Each patient will be different here. In my experience, this has been to psychosis/mania with previous steroid exposure.There is clear data that you can omit steroids following cycle 1 with daratumumab-based induction, cited here, but there are othe...
Is there any emerging data demonstrating the utility of performing gene expression assays in TNBC to understand potential chemotherapy sensitivity?
Chemotherapy drug-specific predictive markers have been impossible to find so far. General chemotherapy sensitivity features have been found, but are not part of any currently clinically used assay. High expression of DNA damage repair genes and high expression of immune-related genes have both been...
When recommending salvage RT post-prostatectomy for an ultra-sensitive PSA level <0.1, do you still recommend concurrent hormonal therapy?
There is potentially an interaction between ADT's benefit and the PSA at the time of treatment. This was most well delineated in RTOG 9601 (Dess et al., PMID 32215583), but since then, using modern LHRH agonists, that interaction has been less well established (GETUG-AFU16, SPPORT, and RADICALS-HD)....
Any role for adjuvant systemic therapy for resected sebaceous skin carcinoma?
There is no data about this situation.I would probably treat adjuvantly if margins are positive or if there are localized metastatic lesions that were resected with the primary surgery. I strongly recommend genomic studies to look at mismatch repair, as 25 to 30% of cases could have a deficiency and...
How do you talk with your patients regarding radiographic expectations on surveillance CT after lung SBRT?
In general, especially when I have a discussion about the 3-month follow-up scan and tell patients that the lesion may likely be stable in size, which is often normal, and not to panic. There may also be post-radiation changes that make it more difficult to initially interpret. I think this highligh...
How do you approach adjuvant chemotherapy in an adult with localized osteosarcoma who demonstrates 50–90% tumor necrosis on surgical pathology following neoadjuvant doxorubicin and cisplatin?
There remains controversy regarding this. The largest trial to compare MAP (continuation of induction therapy into consolidation therapy) vs MAP-IE (addition of IE to conventional MAP) - EURAMOS-1 did not show any benefit to the addition of IE; however, certain centers still do so (i.e., MD Anderson...