Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Do you utilize Oncotype Dx or other multigene assays to guide adjuvant chemotherapy for ER+ HER2- breast cancers that are pT3N0?
Size matters when it comes to prognosis, but biology matters more when it comes to prediction of chemotherapy benefit. Evidence for the prospective Plan B trial indicating good prognosis in patients with high risk node-negative and 1-3 node-positive ER+, HER2- breast cancer with endocrine therapy al...
What is your preferred first line therapy in metastatic ALK+ NSCLC?
For patients with known CNS metastases at baseline, lorlatinib may potentially offer better CNS disease control, albeit with more toxicity relative to brigatinib/alectinib. Brigatinib is more convenient in terms of dosing from the patient perspective (one tablet once daily versus up to four twice da...
How do you follow/manage patients with metastatic prostate cancer with undetectable PSA and castration-sensitive but active disease on PSMA PET?
Summary: This is a challenging clinical scenario, and one in which I think there is currently a lot of practice variability. In such cases, I would not jump to action immediately, and I would first try to obtain some additional information. This would include repeat PSA for confirmation as well as f...
How do you manage prostate cancer in patients that cannot swallow pills?
The only one suitable for feeding tube administration is apalutamide (must be 8 French or greater feeding tube size). My oncology pharmacist suggests tablet(s) can be placed in a syringe (whole, not crushed), distilled water then added, shaken vigorously to disperse contents, administered through...
What are your top takeaways in Head & Neck Cancers from ASCO 2025?
The phase 3 KEYNOTE-689 and the phase 3 NIVOPOSTOP. A key distinction is that KEYNOTE-689 incorporated both neoadjuvant and adjuvant immunotherapy, while NIVOPOSTOP restricted immunotherapy to the adjuvant phase and specifically targeted patients with high-risk features (+ margins and ECS) post-surg...
What are your top takeaways in Gyn Cancers from ASCO 2025?
We had some exciting abstracts for ASCO 2025! These gynecologic oncology abstracts highlight some truly impactful advancements. Here's a concise breakdown of the key findings and their potential implications: 1. CALLA Trial – ctDNA Detection in LACC (Abstract #5502, Dr. Mayadev et al.)Study Focus: E...
What are the best radiation therapy options for a young adult with 3 brain metastases from myeloid sarcoma that hasn’t responded well to intrathecal therapy?
The prognosis for young adults with Acute Myeloid Leukemia (AML) experiencing a Central Nervous System (CNS) relapse is generally poor, with most studies reporting a 5-year overall survival rate of ~11%, indicating a very grim prognosis due to the aggressive nature of CNS involvement in AML.The prec...
Under what circumstances would you consider irradiation for brain metastases with active or recent bleeding?
Melanoma and renal cell cancer brain metastases are prone to bleed. When metastases bleed, usually they cause acute symptoms depending on the location within the brain (seizures, sudden onset headaches, acute motor dysfunctions, etc.). These patients are commonly seen in the Emergency Department, at...
How well does a negative non-contrast MRI of the brain exclude metastasis in a patient with squamous cell carcinoma of the lung?
I don't think the question has enough information to give a good answer. For example, if it was a T3, N2 NSCLC, or a small cell, then "yes" I'd repeat the MRI with contrast. On the other hand, if it was a T1, N0 NSCLC, then "no", I wouldn't. In other words, if I thought there was a real risk of havi...
How do you approach the workup and initial treatment of systemic AL amyloidosis?
1: Ensure that this is light chain. Mass spectroscopy of the tissue to identify/confirm is very important. Even if a patient has positive serum monoclonal protein or light chain, it does not indicate that this is light chain amyloidosis. I have had patients with MGUS and smoldering myeloma with ATTR...