Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Would you use a hippocampal sparing technique when treating with PCI for a limited stage small cell lung cancer?
This is an important question where the evidence is evolving, and some key trials remain ongoing. Because the data remains in flux, in the ongoing phase 3 SWOG S1827/Maverick trial of MRI surveillance +/- prophylactic cranial irradiation (PCI) for LS and ES-SCLC, where I serve as the PI, hippocampal...
How do you approach palliative RT dose selection to skeletal lesions in patients with Myeloma who are actively receiving or likely to need systemic therapy?
Multiple myeloma patients with painful bone disease often present a unique constellation of clinical characteristics, such as extensive skeletal involvement, longer life expectancies, and many prior or anticipated systemic treatments. Some key features influencing my choice of radiation dose and sch...
How do you approach palliative RT dose selection to skeletal lesions in patients with Myeloma who are actively receiving or likely to need systemic therapy?
Multiple myeloma patients with painful bone disease often present a unique constellation of clinical characteristics, such as extensive skeletal involvement, longer life expectancies, and many prior or anticipated systemic treatments. Some key features influencing my choice of radiation dose and sch...
In what situation would you recommend ipilimumab + nivolumab over relatlimab + nivolumab in the treatment of metastatic melanoma?
There is no clinical trial to provide a direct comparison between the two regimens, hence the answer to this question is usually driven by personal interpretation of the data and patient preference. The data for both regimens show a statistically significant PFS benefit and a superior response rate ...
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...