Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Is there a correlation with severity of rash as an adverse event and response rate with capivasertib?
While it is tempting to hope that patients with significant side effects on targeted therapies might be more likely to demonstrate an antitumor response to that treatment, and there is limited data to suggest a possible correlation between immune-related adverse events and response to immunotherapy,...
What are your first line treatment choices for metastatic combined HCC/Cholangiocarcinoma?
Combined HCC/Cholangiocarcinoma is a rare phenotype and there is a paucity of data on the right treatment. If a biopsy is obtained, I would try to obtain several sites and send for molecular testing to see the different clones/mutation profiles. In clinic, I have tried to combine gemcitabine/cisplat...
How would you approach a patient with a carotid body tumor and metastasis to the cervical lymph node?
All such patients should be evaluated by a qualified otolaryngologist for removal of the primary tumor and the affected lymph nodes with a selective neck dissection. Surgery is considered the primary treatment for cure. For incomplete resections, adjuvant radiation therapy should be considered for i...
What factors do you consider when deciding between dual vs single-agent immunotherapy for patients with MSI-H or dMMR metastatic CRC?
Given all the data we have, I am personally biased and prefer dual immunotherapy for most mCRC patients unless there is significant concern for tolerance (frail patients, limited disease burden, underlying well-controlled certain auto-immune disease, etc).
How should you approach treating curable laryngeal cancer with chemo-RT in a patient who had a myocardial infarction during treatment and requires CABG, given the cardiotoxicity of cisplatin and 5FU/carboplatin?
Wow - tough situation. I would largely be hesitant to give chemo to someone who requires a CABG, which also implies that stents were not placed, etc. I would also want to know if it was a STEMI or not, angiogram results, EF, etc. I think the stage of the cancer, other comorbidities, goals of the pat...
Given the results of ESOPEC from ASCO 2024, for which patients with resectable esophageal adenocarcinoma would you favor neoadjuvant chemoradiation?
It is a great question and something that I think all of us are still wrestling to digest and readjust our treatment algorithm for patients with esophageal cancer. First, I think Dr. @Dr. First Last did an outstanding job putting ESOPEC in context in the esophageal cancer treatment landscape. In add...
Does it matter whether one uses MSI PCR testing versus IHC for MMR deficiency testing in order to determine eligibility for immunotherapy?
Immunohistochemistry (IHC) assays detect dMMR, or deficiency in the mismatch repair proteins. Polymerase chain reaction, or PCR, detects microsatellite instability-high (MSI-high) status at the genomic level. Functionally, they mean the same thing - tumors that test positive for either assay should ...
How do you approach treatment of localized small cell bladder cancer?
Localized small cell bladder cancers often are upstaged at surgery and show aggressive behavior. I offer 3 months of neoadjuvant chemotherapy (Cisplatin and Etoposide), followed by radical cystectomy for most patients who are surgical candidates (see MD Anderson data, Lynch et al, Eur Urology, PMID ...
Is there a risk of increased side effects with combined radiation and ibrutinib therapy?
It is increasingly common to see patients with various hematologic malignancies requiring palliative RT who are on small molecular inhibitors (such as ibrutinib) or other novel agents. There is often a dearth of information in the medical literature regarding the safety of combining RT with these dr...
Is there a risk of increased side effects with combined radiation and ibrutinib therapy?
It is increasingly common to see patients with various hematologic malignancies requiring palliative RT who are on small molecular inhibitors (such as ibrutinib) or other novel agents. There is often a dearth of information in the medical literature regarding the safety of combining RT with these dr...