Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Is there evidence supporting the role of SBRT in the management of oligometastatic stage IV NSCLC?
Yes. I would look at a great trial from Wake Forest, looking at consolidative radiotherapy after 3-6 cycles of platinum-based chemotherapy, followed by observation, so chemotherapy, then radiotherapy, then observation (no maintenance chemotherapy). The trial occurred from 2010 to 2015. This single-a...
Would you recommend large-field radiation therapy to treat SCC of the skin with field cancerization (e.g., entire forearm, scalp) in elderly patients with CLL/immune compromise who have had mixed responses to cemiplimab?
Yes, retrospective data from Australia support large fields using VMAT at a median dose of 47.9 Gy in an average of 23.9 fractions with treatment breaks as needed and using a custom bolus. The photos in the article help clarify what is meant by 'field cancerization.' This phenomenon is termed extens...
Is there any antiresorptive therapy that you would be comfortable prescribing if the patient refuses to see a dentist for clearance and is at risk of skeletal-related events?
For patients with hypercalcemia of malignancy, I don't usually worry about dental care. For everyone else, short answer is no.The "secret" about anti-resorptive therapy is that it provides clear benefits in patients that have myeloma that is not well-controlled (PMID 8559201, 9469347). Things become...
Is there any way to safely treat patients with mCRPC with 177-Lu PSMA who are on hemodialysis?
For the most part, no. Not unless you're a big academic medical center with a robust multidisciplinary team willing to tackle the significant logistical challenges associated with this scenario.I'm aware of no literature in this scenario specifically for Pluvicto, but we can look at the radiopharmac...
How would you change the regimen for a patient receiving neoadjuvant TCHP or node positive HR+/HER2+ breast cancer who develops a severe allergic reaction to docetaxel?
I would favor replacing docetaxel with nab-paclitaxel and continue carboplatin along with trastuzumab and pertuzumab, as the data would suggest that in HER2+ breast cancer, the taxanes are more important than anthracyclines (as seen in BCIRG-006 and TRAIN-2) and that the taxanes offer synergy with H...
For a patient treated with abiraterone for first line metastatic prostate cancer, would you still use a combination of abiraterone/olaparib at a subsequent progression?
No, there is no evidence for this, and in the absence of benefit, I would use single agent olaparib in HRD+ patients only, particularly BRCA2 patients. Ongoing trials like the CASPAR trial will address this question. In addition, there are ongoing trials testing PARP/AR combinations in men with mHSP...
What adjuvant therapy would you offer to a young patient with resected margin-negative stage III extrahepatic cholangiocarcinoma?
I would strongly consider using the @Dr. First Last SWOG 0809 trial of chemotherapy and chemoRT adjuvantly - this is assuming you have a radiation oncologist who is also supportive. This is more positive data than the BILCAP study, which showed a *very* modest effect of adjuvant capecitabine Primros...
When do you recommend initiation of targeted therapies in active RA with history of malignancy?
In patient with RA and a history of malignancy, I generally recommend the same therapy that I would recommend in the absence of a malignancy history. This is consistent with the most recent ACR guidelines for the management of RA (Fraenkel et al., PMID 34101387). Consistent with FDA labeling, I'd ge...
Would you ever recommend testosterone replacement for men with incomplete T recovery after ADT for prostate cancer?
I have been hesitant to agree to supplemental testosterone after prostate cancer treatment, especially within the first few years. Prostate biopsies during that time often show atypical cells that are suspicious or adenocarcinoma with treatment effect. Androgens are pro-survival and the full effects...
What is your recommended treatment sequencing strategy in patients with HER2+ breast cancer and leptomeningeal carcinomatosis?
HER2+ breast cancer and leptomeningeal carcinomatosis is a very challenging situation but we have more options than ever before. While the DB-12 study excluded patients with leptomeningeal metastases, T-DXd (trastuzumab deruxtecan) has shown excellent activity in retrospective series and small prosp...