Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How do you manage perioperative anticoagulation for a patient with a history of recent, surgically provoked VTE?
In most cases, bridging is rarely indicated because the bleeding risk usually outweighs the risk of VTE recurrence during a short (1–2 day) interruption of anticoagulation. However, after a recent VTE (defined as <3 months), the estimated risk of VTE recurrence is high (>15–20% per year) (still low ...
When would you use rusfertide to treat polycythemia vera?
I think of rusfertide as being a very effective adjunctive therapy for patients with PV who are on cytoreduction and still requiring phlebotomy! Given the impact of inducing a molecular response when using a cytoreductive therapy in the treatment of PV, as has been seen across a variety of studies, ...
Would you continue cemiplimab adjuvantly, following resection of initially unresectable cutaneous squamous cell carcinoma treated with downstaging immunotherapy?
This is a challenging question because, as you know, we have no randomized data to address it. I generally do not continue immune checkpoint therapy after resection of SCC skin. However, given the adjuvant data in melanoma and the high efficacy of anti-PD1 in skin SCC, I do think it is reasonable to...
Given the recently published results of PEACE 2, under what scenario would you offer pelvic radiotherapy for high-risk/very high-risk prostate cancer?
Although PEACE-2 was presented at GU ASCO, to my knowledge it has not yet been published other than in abstract form, and the results of the arms in PEACE-2 comparing prostate only vs whole pelvic RT were not presented, so I don't think PEACE-2 sheds any light yet on the question of whether or not t...
How do you determine which systemic therapy to recommend in the 2nd line setting for metastatic, PD-L1 NEGATIVE cervical cancer?
This is a very difficult situation because none of the available options are effective. Clinical trial or possibly pembrolizumab on compassion-care usage.
What are best practices for medical oncology clinics during the COVID-19 pandemic?
Agree with @Dr. First Last's response. Here are some of our guidances (with the caveats that there are exceptions to all of these, and they are dependent on clinician-patient discussions): Patients with active COVID-19 infection Delay/stop oncologic therapy (chemotherapy, radiation, surgery) until ...
For a patient with metastatic, poorly differentiated esophageal adenocarcinoma with an excellent systemic response to chemotherapy for 1 year, who now presents with isolated local progression and no new distant disease, would you consider treating the primary site with a higher palliative RT dose for more durable control?
For genuine oligoprogression limited to the primary tumor, in a patient who is otherwise fit and responding to systemic therapy at distant sites for ≥1 year, I would definitely consider a higher RT dose aimed at durable local control, not just short-term symptom relief. The exact regimen would obvio...
When do you choose dose-dense chemotherapy v. q3 week therapy in advanced epithelial ovarian cancer?
In our recent OGR, we suggested an approach to deciding which patients might be appropriate for considering the dose-dense regimen in the first line setting (Figure 2). The dose-dense JGOG regimen was shown to confer an overall survival advantage in newly-diagnosed patients with advanced disease (es...
For early-stage, HR+ Her2- breast cancers, when do you use OncotypeDx v. Mammaprint?
The reason to use any multiparameter assay is to determine which patients need chemo and which don't. To say that another way - it is about the predictive ability, not the prognostic ability. Until very recently, Mammaprint only had prognostic data so I always used Oncotype. The MINDACT trial recent...
How do you manage a patient with multiple similar appearing ground glass opacities (~8-9) on Chest CT where one has been surgically removed and confirmed to be adenocarcinoma in situ?
This is a common scenario. Determining the stage of lung cancer can be challenging. Many patients, especially those with chronic lung disease, will have multiple non-specific abnormalities seen on CT scans. The patient with multiple GGO's on CT can be especially challenging. GGO's can represent canc...