Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Would you ever consider adjuvant chemotherapy for a patient with rectal cancer treated with RAPIDO total neoadjuvant therapy after positive PNI was found on the surgery?
The patient should have received adequate systemic therapy per the RAPIDO trial; therefore, additional chemotherapy will not add any further benefit.
Does delay to the time of lumpectomy impact your decision to omit radiation?
There seem to be two issues to consider in this situation. One is whether patients undergoing neoadjuvant endocrine therapy, then lumpectomy without RT, have an acceptable local recurrence rate. The only study I know of directly addressing this issue was presented at a poster session of the 2017 San...
How would you approach systemic treatment of oligometastatic recurrence following surgical removal of the single area of metastasis in a patient with ER+ (20-30%), PR-negative, HER2-negative breast cancer?
I would most likely start the patient on endocrine therapy and a CDK4/6 inhibitor. Even though the response rate is lower with this approach in patients with lower hormone receptor-positive breast cancer, it can still be a reasonable option, and it would avoid chemotherapy-related risks and toxiciti...
In which patients with stage 1 triple negative breast cancer would you utilize neoadjuvant chemotherapy?
Overall, neoadjuvant administration of chemotherapy is appropriate whenever adjuvant chemotherapy is indicated. There is clinical benefit from administering chemotherapy to cancers > 2cm because patients are often end up with smaller surgical resection than in the absence of neoadjuvant chemotherapy...
Should axillary imaging be routinely performed in all patients with a new diagnosis of breast cancer?
This issue has been debated but I would argue that patients with a new diagnosis of breast cancer should not undergo routine screening US of the axilla to look for clinically occult disease. The axillary US should be limited to diagnostic imaging for clinically suspicious nodes on clinical exam or b...
In which patients with atypical HUS would you consider eculizumab discontinuation?
My approach to eculizumab cessation in aHUS is to at least consider cessation in all patients not only given the high cost of the drug, but also given the risk of meningococcemia, which is incompletely protected against by vaccines.In treating aHUS, I initiate eculizumab (and preventive therapy for ...
In patients receiving adjuvant cemiplimab for high-risk cutaneous SCC, what is your standard surveillance strategy for detecting relapse?
Ultrasound (US), Computed Tomography (CT), Positron Emission Tomography (PET), and Magnetic Resonance Imaging (MRI) are all options for radiographic surveillance of patients at very high risk for cSCC disease relapse. Understanding the clinical presentation, tumor histology, and patient factors can ...
Do you recommend GLP-1 agonists in patients with MPN?
I don't think that there is a compelling reason to start a GLP-1 agonist without another indication. With that said, there was a provocative recent abstract at SOHO suggesting a significant reduction in mortality, thrombosis, and disease progression in GLP-1-treated PV patients compared to those who...
Do you recommend GLP-1 agonists in patients with MPN?
I don't think that there is a compelling reason to start a GLP-1 agonist without another indication. With that said, there was a provocative recent abstract at SOHO suggesting a significant reduction in mortality, thrombosis, and disease progression in GLP-1-treated PV patients compared to those who...
Would you offer cisplatin concurrent with radiation to a patient with p53-mutated stage III endometrial cancer if she has adult-onset hearing loss and uses a cochlear implant?
Cisplatin is commonly used for radiosensitization in patients being treated for gynecologic cancer. Ototoxicity is a common side effect of cisplatin. It is caused by the death of outer hair cells in the inner ear. Cochlear implants are used to treat hearing loss in patients with severe hearing loss ...