Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How do you approach adjuvant chemotherapy in patients with resected pancreatic adenocarcinoma?
For my good performance status patients, I offer gem/cap as per the ESPAC-4 trial. Though the incremental benefit is modest, it was statistically significant and the toxicities associated with the combination are quite manageable most of the time. I look forward to the results of three other adjuvan...
Do you offer adjuvant therapy for localized medullary carcinoma of the ascending colon that is MSI-H?
Medullary carcinoma of the colon is a rare type of colon cancer with unique clinical and molecular features. Despite its high-grade histology, its prognosis is generally better than adenocarcinoma. They tend to be locally advanced and rarely metastasize. They are usually MSI-H with a high number of ...
What is the treatment strategy and priority in a patient with newly diagnosed Hodgkin lymphoma but HLH at presentation?
Would be good to have more details about the patient's medical condition and organ function. How definitive is the HLH diagnosis as against Hodgkin's with B symptoms? Malignancy-associated HLH at diagnosis is due to cytokines/chemokines produced by the tumor cells, so the major part of the therapy i...
How would you approach mantle cell lymphoma in very elderly patients?
For patients who are very elderly, my approach depends on the patient's performance status, other comorbidities, disease features/disease behavior, and indications for treatment. There are patients with MCL who can be observed at diagnosis (those with leukemic non-nodal disease but also those with l...
How would you approach mantle cell lymphoma in very elderly patients?
For patients who are very elderly, my approach depends on the patient's performance status, other comorbidities, disease features/disease behavior, and indications for treatment. There are patients with MCL who can be observed at diagnosis (those with leukemic non-nodal disease but also those with l...
How are you counseling HR-proficient ovarian cancer patients about front line PARP inhibitor maintenance?
I think this is a tough decision, but I recommend observation for patients with HR proficient disease. In brief, I don't find a PFS advantage, without a proven OS advantage, enough to justify this long-term, expensive, and not non-toxic treatment.For BRCA carriers the answer is easier—with SOLO2 (20...
When treating breast cancer patients with RNI, how often do you include internal mammary nodes?
Treating the internal mammary nodes (IMNs) increases heart and lung exposure; hence, the value of prophylactic IMN RT has been controversial for decades. Randomized trials suggest there may be some benefit to such treatment but disagree on which patient subgroups benefit most or not at all.A trial c...
What scenarios, if any, are you delaying adjuvant chemotherapy in light of the COVID-19 outbreak?
This is a complex issue that our group here at MSKCC is dealing with right now, with formalized guidance pending. This is in mind of the fact that the mortality rate in Chinese patients with cancer approached 6%. While I wouldn't delay starting adjuvant therapy—which is being given with curative int...
How do you determine which systemic therapy to recommend in the 2nd line setting for metastatic, PD-L1 NEGATIVE cervical cancer?
This is a very difficult situation because none of the available options are effective. Clinical trial or possibly pembrolizumab on compassion-care usage.
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