Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
What adjuvant treatment would you recommend for a patient with FIGO 2023 IIIB2 endometrioid endometrial adenocarcinoma (Grade 3, p53mut, MMR proficient), metastatic to the uterine serosa, bilateral ovaries, and anterior peritoneal reflection?
Chemotherapy followed by pelvic RT
What are your top takeaways in Radiation Oncology from SABCS 2024?
Wine regions have good years and bad years. This year's vintage from San Antonio was exceptionally fine, with oral presentations of several important, highly anticipated trials. The second and third of the studies I will discuss were also published on the day of the oral presentation.1. GS2-03: Kunk...
Would you recommend enfortumab vedotin plus pembrolizumab for localized advanced non-invasive urothelial carcinoma of the renal pelvis?
Urothelial carcinoma of the renal pelvis is always challenging to stage and is often understaged. However, it would be difficult to justify systemic therapy with EV + P for non-invasive disease on the path. This patient will likely need upfront RNU followed by adjuvant therapy based on pathological ...
What is your approach to cancer patients who inquire about alternative or complementary treatments?
It depends a little bit on what specifically they want to use, and if they are truly investigating alternative medicine or complementary medicine. For people seeking full alternative medicine without any conventional treatment, I tell them that a research study showed that people who pursued the alt...
What is your approach to cancer patients who inquire about alternative or complementary treatments?
It depends a little bit on what specifically they want to use, and if they are truly investigating alternative medicine or complementary medicine. For people seeking full alternative medicine without any conventional treatment, I tell them that a research study showed that people who pursued the alt...
How do you monitor for cardiac toxicity in patients taking osimertinib?
There are multiple studies that have explored the issue of cardiotoxicity from osimertinib. A large single-center retrospective observational cohort series from Taiwan, (n=401) compared a matched cohort of patients treated with osimertinib (n=253) to those treated with other EGFR TKIs (n=195) and fo...
What systemic therapy would you use in T3N1M1 MMR proficient rectal cancer with solitary liver lesion when going for curative intent (chemo>short course RT> resection of primary and liver met)?
Hi,I think this is an important question. For resectable disease, most data we have is from the EORTC 40983 trial in which FOLFOX was used. For borderline resectable, you could consider FOLFOXIRI based on the OLIVIA trial. That being said, obtaining molecular profiling for this patient is key which ...
Would you consider using ensartinib in patients with ALK-positive NSCLC who have progressed on alectinib and lorlatinib?
I've written about this previously (https://www.themednet.org/question/23471). The question invokes a conceptual model of cancer therapy sequencing from the chemotherapy era, where it was the norm to go through lines of therapy with diminishing returns (e.g., platinum doublet, then docetaxel, then g...
How do you treat Stage IIIC T4N3 NSCLC?
Probably need a bit more information since T4 is fairly heterogeneous, but it is absolutely treatable. If it involves both ipsilateral lobes, then SBRT to one isolated lesion and CRT for the rest is one approach. If T4 is involved in critical mediastinal organs, probably some induction therapy with ...
For an elderly woman with a platinum-resistant recurrence of a high-grade serous ovarian cancer who has been rendered NED surgically, is observation a reasonable approach?
Based on her age, performance status, and goals of care, it is certainly reasonable to discuss all options with patients. With her being platinum resistant, I would counsel on prognosis and the need to consider quality of life. With the need for balance between QoL and OS, waiting until there is a m...