Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
What is the role of liquid biopsy in patients with metastatic castration resistant prostate cancer to asses BRCA1/2 or other mutations and consider PARP inhibitors?
There are no FDA cleared tests that have been shown to accurately predict response or benefit from PARP inhibitors in men with prostate cancer. The risk of both false positives and false negatives remains high with these assays due and no studies in prostate cancer have shown concordance with a high...
For patients with cT1-T3 cN0 cM0 mid/low rectal cancer seeking organ preservation, what treatment approach do you recommend?
This is an important question; however, the answer is unknown. The key outcome that should be the focal point for the best treatment option, is which treatment strategy results in the most optimal patient reported quality of life and bowel function. Currently, this remains void of prospective, rando...
For patients with HCC that have stable disease on immunotherapy alone, would you consider adding bevacizumab at the time of disease progression and continue immunotherapy?
Yes, this is applicable to patients who are on single agent immunotherapy, since the atezo/bev combination carries different mechanism of synergistic potential than single agent immunotherapy. Notably, currently approved second line agents are indicated after progression on sorafenib, however, curre...
How do you decide which immunotherapy agent to utilize for 1st line in PD-L1 high (>50%) NSCLC?
Now with the approval of atezolizumab based on the positive Impower110 study (led by @Dr. First Last and @Dr. First Last), we have 2 frontline checkpoint inhibitors to choose from. Indeed the data appears very convincing for both, therefore on scientific grounds, I would not be able to choose one ve...
Does high risk cytogenetics as a sole abnormality influence your treatment decision for smoldering multiple myeloma?
Several studies have looked at the prognostic factor of FISH abnormalities and risk of progression of SMM to active disease (Neben et al., 2013; Rajkumar et al., 2013). Deletion 17p and t(4;14) are associated with the highest risk of progression, with median time to progression of 24 months, as repo...
Is there any role for bisphosphonate or alternative bone-modifying agents use in SMM in the absence of other indications for its use?
The short answer is no, unless the patient has an indication like osteoporosis. Bisphosphonates have been evaluated in smoldering multiple myeloma in studies performed over 10 years ago. Treatment with pamidronate (D’Arena et al., 2011) or zoledronic acid (Musto et al., 2008) did not affect the time...
When discussing immunotherapy with patients, how do you frame the conversation in a way that acknowledges the fact that many patients do not respond but allows for hope for a durable response?
There is certainly more than one way to do it. The best way depends on knowing the learning style and information preferences of your patient and then tempering information that they need to have to be informed appropriately. The Shared Decision Making [SDM] model encourages us to invite the patient...
For women who have had either embryo or oocyte cryopreservation, do you also recommend administering GnRH analogs?
For anyone who is interested in fertility preservation enough to undergo egg or embryo cryopreservation, I think offering GnRH analog treatment through chemotherapy for prevention of premature ovarian insufficiency and potentially infertility makes sense. Although some women may not want to deal eve...
What is the recommended follow-up/surveillance schedule following organ preservation treatment approach for cT1-2N0 rectal cancer?
Patients with stage I rectal cancer treated with organ preservation require close surveillance to rule out tumor regrowth and local recurrence that may be salvaged with radical surgery. The highest risk of recurrence is within 2 years after completion of neoadjuvant therapy and patients should be fo...
Is there a subset of breast cancer patients who may benefit more from GnRH analogs for fertility preservation compared to others?
In the prior research and the meta-analysis conducted by Lambertini et al., use of GnRH was not associated with any group of premenopausal women doing worse from a disease standpoint. Further we now know from the Suppression of Ovarian Function with Triptorelin Trial (SOFT) that adding ovarian suppr...