Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Are any centers routinely using 55 Gy in 20 fractions with chemotherapy for definitive treatment of head and neck cancer following presentation of the HYPNO study?
I would not consider 55 Gy in 20 fractions a standard approach. The comparator arm was not standard practice in the US (66 Gy in 33 fractions with 5 weekly cycles of cisplatin at 35 mg/m2). Both the total RT dose (66 Gy < 70 Gy) and the total cisplatin dose (cumulative dose 175 mg/m2, less than the ...
Would you prioritize TACE or systemic therapy in BCLC B multifocal HCC with tumor bulk higher than "up to 7?"
This is a challenging area where we need more definitive studies. With the info available, I do favor systemic therapy for such patients. Liver directed therapy is unlikely to lead to adequate control for such multifocal disease and the patient is likely to require multiple treatments to different a...
How do you approach the treatment of de novo, brain-only metastatic HER2 positive breast cancer?
Patients who present with de novo, brain-only metastases of HER2+ breast cancer are rare, and hence, there is no good clinical experience or clinical trial basis upon which to base clinical practice recommendations. The current ASCO guidelines for the management of HER2+ brain metastases call for ap...
Should we be utilizing prophylactic G-CSF in our patients with intermediate risk of febrile neutropenia due to the COVID-19 pandemic?
There are many functions of G-CSF, including repression of T-cell and NK cell function. Unless you are certain that growth factors are not modifying the immune network to the detriment of viral clearance—there is no data that growth factors help clear viral infections.
How should you manage a coronavirus infected/suspected patient who is receiving radiotherapy and cannot interrupt or delay their cancer treatment?
Hi Everyone, I agree with all the comments—this is certainly a fluid situation. We have not had a confirmed COVID-19 case, but we have developed a plan. If it is deemed a known COVID-19 patient, and it is elected to continue treatment by the treating physician, the treatment will happen at the end o...
How will your management of head and neck cancers change with the COVID-19 pandemic?
Short answer: Most head and neck cancer radiation is as necessary as it gets. At this point, my management won't change very much. That may change as the pandemic evolves. Use all the appropriate precautions to stop the spread of COVID-19 and other viruses (we are using masks for every staff member,...
How would you approach missed doses of fulvestrant due to COVID-19?
There is no specific guideline for this. But, as we do for patients who occasionally miss fulvestrant doses, I would try to schedule the next dose as soon as possible. Another option would be to consider an alternative endocrine therapy option such as AI, tamoxifen, which do not require for patients...
Would you offer radiation for suspected retroperitoneal nodal metastases in a patient with metastatic colorectal cancer with a single liver metastasis who had an excellent response to neoadjuvant chemotherapy?
Yes, in the setting of all other disease likely controlled and response to systemic, the control of the RP nodes (gross and microscopic) should be considered definitive and curative. RP/PA nodes should be considered N2 rather than M1. As such, elective nodal RT should also be given with IMRT, not SB...
In what cases of T3N0 glottic SCC, would you omit chemotherapy and offer radiation alone?
The question seems to stem from a presentation of a patient that would have historically been stage 2, but more recent editions of AJCC and more refined imaging have upstaged the patient to stage 3 by calling minimal paraglottic extension on an MRI. This is similar to a previous question where a pat...
Would you recommend radiotherapy for upper-tract urothelial carcinoma in an inoperable patient?
Unfortunately, there are no good data to guide a decision in this circumstance. Assuming that this is a patient with a small tumor localized to the upper tract with no evidence of nodal or distant disease, radiotherapy might be a reasonable option to either palliate symptoms due to obstruction or bl...