Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Given the results of KEYNOTE-A18, do you plan to recommend adding pembrolizumab to primary chemoradiotherapy for advanced stage cervical cancer?
Until the paper gets published, we won't really know a lot of details that may influence the potential utility of this regimen. It has an abstract/presentation and has recently received FDA approval.It is a relatively 'newer' idea in improving outcomes that we as an institution are open to start off...
Is REZUM (water vapor thermotherapy for BPH) safe after EBRT?
Although I am not aware of any studies evaluating the toxicity rates in patients undergoing REZUM after RT, I am aware of a few studies reporting the toxicity of TURP after RT. For example, Liu and colleagues conducted a retrospective review of the outcomes of 1,192 patients, 246 of whom underwent a...
Are there any adverse risk factors in stage I colon cancer that would warrant ctDNA testing?
I would not check ctDNA in this setting. If there is an adverse feature of the tumor and the patient is a candidate for further treatment, I would do close surveillance imaging and CEA at the most. A recent publication of a larger cohort study of stage II to IV resected colorectal cancer suggests th...
How would you manage a large area of multiple, recurrent cutaneous squamous cell carcinomas of the scalp with ulcerations and non-healing areas despite cryotherapy, multiple Mohs procedures, and 5-FU?
Consider sending the patient to medical oncology for evaluation for cemiplimab. Large areas of the scalp can also be treated by making a 1 cm "cap" of bolus and utilizing VMAT to cover scalp soft tissues, with elective coverage of nodes and perineural pathways if indicated.
What is your preferred choice of therapy for first-line treatment of a patient with good, intermediate, or poor risk stage III nonseminomatous germ cell tumor if the patient is truly cisplatin-ineligible?
The first question is what makes the patient "cisplatin-ineligible". Cisplatin has been given in patients on hemodialysis, guided by cisplatin levels and timing of dialysis. In someone with first-line intermediate and poor-risk disease, cisplatin is indispensable in my view.
What is your preferred mode of vascular access for testicular cancer regimens?
Actually, we try to avoid all vascular access devices, especially PORT, which causes a 10-20% risk for clot as well as infection. These are young healthy patients usually with excellent veins. Over 90% of our large patient populations with testis cancer simply get their 5 days of chemo with a restar...
How would you treat a T2N1 ER 90%, PR 10%, HER-2 negative breast cancer in premenopausal women with a tumor abutting the pectoralis fascia with loss of fat plane, with a concern for a positive surgical margin?
I would strongly consider neoadjuvant chemotherapy to improve resectability, assess treatment response, and reduce the risk of positive margins and extensive axillary surgery. Given the tumor’s proximity to the pectoralis fascia with loss of the fat plane, there is a real concern that upfront surger...
For patients with PI3K mutated metastatic breast cancer who progress on a PI3K inhibitor, will you use an alternative PI3K inhibitor subsequently?
Currently, there is no robust clinical evidence supporting the sequential use of different PI3K inhibitors after progression on a prior PI3K inhibitor. The INAVO120 trial (and CAPItello-291 for capivasertib) excluded patients who had prior treatment with any PI3K, AKT, or mTOR inhibitor, or any agen...
Is there specific data on using luspatercept for sickle beta+ thalassemia with transfusion-dependent anemia?
There is no data currently on the use of luspatercept in any condition other than beta thalassemia, including HbE-beta thalassemia. It has been studied in the beta thalassemia phenotype, both transfusion-dependent and non-transfusion-dependent (adult data published, pediatric trial underway), but no...
What is the preferred steroid regimen for metastatic prostate cancer patients on docetaxel?
TAX 327 (Tannock Et al NEJM 2004) used prednisone 5 mg bid in all patients (Q3 week Docetaxel and weekly Docetaxel). In addition, patients received dexamethasone 8 mg 3 times (12, 3, and 1 hour) before infusion. The prior phase 2 studies did not include prednisone with Docetaxel. Historically, low-d...