Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How would you manage symptomatic superficial vein thrombosis during pregnancy?
The best evidence for the treatment of SVT comes from the CALISTO trial, which endorsed a prophylactic dose of fondaparinux as the treatment of choice. However, the CALISTO trial excluded pregnant women. Because data on the use of fondaparinux in pregnancy remain limited, with some traces of fondapa...
How long would you recommend a woman with HR+ node-positive breast cancer treated with surgery and chemotherapy during pregnancy can breastfeed, prior to starting adjuvant endocrine therapy?
I agree. This is unfortunately, an area with a lack of data, though in my experience, most women who are treated for breast cancer during pregnancy are still in the middle of therapy (systemic or local) after delivery, so we typically recommend against breastfeeding to avoid delays, particularly wit...
What are your top takeaways from ESMO 2023?
Lung Cancer New first line therapy for advanced EGFR Exon 20 NSCLC patients: The PAPILLION trial [Zhou et al., PMID 37870976] was a Phase 3 clinical trial among patients with locally advanced or metastatic non-small-cell lung cancer (NSCLC) with documented epidermal growth factor receptor (EGFR) ex...
If a patient diagnosed with seminoma after orchiectomy has margin positive disease noted in the spermatic cord and no overt metastasis on imaging and normal tumor markers, how should this patient be staged?
I believe that the staging would be pT3cN0M0S0 in this case. Margin-positive disease suggests continuous rather than discontinuous spermatic cord invasion. In case this was felt to be discontinuous, NCCN v1.2024 now has a note on staging such patients as pT3 (high-risk stage I) and not as M1 (stage ...
In a patient with borderline resectable pancreatic adenocarcinoma who received neoadjuvant FOLFIRINOX followed by resection that demonstrated residual disease, how do you proceed in the adjuvant setting?
In order to answer this question completely, I would need to know more about the neoadjuvant FOLFIRINOX that was given. In a patient who received a full 6 months of neoadjuvant therapy followed by successful surgical resection (albeit with poor response), I would not recommend continuing systemic th...
When should you use caplacizumab in the treatment of acute TTP patients?
Whenever I encounter a patient with features of thrombotic microangiopathy and a normal coagulation panel (that rules out DIC), I consider the possibility they may have immune TTP.If my suspicion of immune TTP is high (e.g. history of autoimmune disease, possible relapse of immune TTP) and there is ...
How would you manage an epidural spinal metastasis causing cord compression from rhabdomyosarcoma?
Leptomeningeal spread of rhabdomyosarcoma could result from the dissemination of tumor cells in the CSF by direct extension or by malignant cells growing along blood vessels or nerve sheaths. I would first get a total spine and a brain MRI to assess where there is gross disease present in other part...
Why is there a benefit of ADT for high risk prostate cancer treated with radiation, yet no large trials describing benefit of adjuvant ADT after radical prostatectomy?
From a high level, the magnitude of the benefit of ADT with radiation seems proportional to the aggressiveness of the disease (i.e. low risk has no significant benefit, int risk weighs risk features and cardiac health, and high risk the benefit of ADT can trump cardiac risk). In that context, we hav...
If a stage I laryngeal cancer completely responds to FU-based chemotherapy (given for another malignancy) would you consider observation?
We expect a 60-80% response rate with induction chemo data, with 20% having a complete response. That doesn’t preclude local treatment but predicts for better outcome.
Does the presence of cribiform histology at biopsy in prostate cancer affect your management in an otherwise intermediate-risk prostate cancer?
There have been no trials on this specific question, so there is room for debate and more science (hoping our recent grant submission in this area gets funded...). Here is my current thinking. This is for generally healthy patients with long life expectancy (≥10 years, but especially if ≥15 years). ...