Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
When do you consider testing for dihydropyrimidine dehydrogenase (DPD) for patients prior to treatment with 5-FU/capecitabine?
Happy to address this question! It is my practice to test for DPD deficiency in all patients who will receive a first treatment with a fluoropyrimidine agent (5-FU or capecitabine). My objective in doing this is to avoid infrequent but readily avoidable severe toxicities and deaths related to DPD de...
When would you recommend abiraterone concurrently with RT for high-risk prostate cancer?
The trial got published in NEJM. It confirms survival advantage and skeletal mets advantage with abiraterone for metastatic disease similar to the Latitude study. This will certainly be an option for metastatic disease at presentation (along with docetaxel until comparative studies comparing docetax...
How do you approach EGFR mutated NSCLC with isolated progression in the chest who is planned for a course of radiation at least 3-4 weeks?
This is an interesting question without a clear answer. There are two competing risks associated with either decision. The risk of continuing osimertinib while radiating chest disease is clearly that of pneumonitis with the overlapping risks from radiation and osimeritinib. The risk of holding osime...
When utilizing KN-A18 protocol, how do you best address symptoms of colitis/cystitis?
I have now anecdotally heard of 2 patients not completing EBRT/Brachytherapy due to the combined AI colitis picture superimposed on a traditional chemoRT GI toxicity. While there were reasons for patients to not complete pre-ICI, those reasons were generally not because of GI toxicity. The main thin...
What factors influence your decision regarding whether to administer a dose-dense chemotherapy regimen in the adjuvant setting to patients with hormone-receptor postive disease?
Many of the studies included in the analyses treated ER+ cases that we would call lower risk using modern genomic testing with adjuvant chemotherapy. So the observed effect of chemotherapy on recurrence and OS in ER+ disease can vary from study to study, depending on the numbers of low vs high risk ...
Should women with adequately debulked ovarian cancer receive bevacizumab with chemotherapy in the adjuvant setting?
The answer to this question is definitively NO.Two large, definitive studies (ICON-7 and GOG218 – including over 3400 patient combined) evaluated the impact of adjuvant chemotherapy with concurrent + maintenance bevacizumab. Analysis of mature data from ICON-7 demonstrated a significant overall surv...
What is the optimal frequency and duration of post-operative radiological surveillance following resection of a solitary fibrous tumor?
Partly depends on the subset of SFT. The classic variant is low-grade, indolent clinical behavior and can recur late (several years later) requiring (maybe less frequent) but long-term follow-up for 10 years or even beyond. The malignant SFTs have a shorter natural history and typical sarcoma follow...
Is there a role for DOAC use for patients with unprovoked PE, that have had recent sleeve gastrectomy with duodenal bypass?
Alterations in the gastrointestinal (GI) tract following bariatric surgery, as well as altered or reduced oral intake, have the potential to impair the absorption of both DOACs and VKAs in the acute setting. DOACs are absorbed in the upper GI tract, which is altered by the most common bariatric surg...
Is there a role for DOAC use for patients with unprovoked PE, that have had recent sleeve gastrectomy with duodenal bypass?
Alterations in the gastrointestinal (GI) tract following bariatric surgery, as well as altered or reduced oral intake, have the potential to impair the absorption of both DOACs and VKAs in the acute setting. DOACs are absorbed in the upper GI tract, which is altered by the most common bariatric surg...