Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Would you recommend radiation or chemoradiation in a patient with cholangiocarcinoma s/p surgery and adjuvant treatment with single hepatic metastasis 3 years later?
Challenging case and worthy of tumor board discussion. I would likely start systemic therapy, and if response, consider regional therapy with resection or SBRT, assuming the hepatic function is adequate (keep in mind, TARE can cause liver disease). I have one patient in a similar situation, now > 5 ...
Should capecitabine be administered at a specific time prior to RT in pre-op chemoradiation treatment for rectal cancer?
We looked at this question and published our analysis in 2007. We looked at the timing of administration and radiation delivery. The dosing of capecitabine was standardized, and the radiation timing was random. The 2-year local control, distant control, and disease-free survival were nearly identica...
What factors do you use to decide between trastuzumab-deruxtecan and sacituzumab govitecan in HER2-low metastatic breast cancer?
Updated answer - 11/26/2024There is currently limited data to guide the efficacy of trastuzumab deruxtecan (T-DXd) after progression on sacituzumab or vice versa. Since both drugs have a topoisomerase 1 inhibitor payload, cancers resistant to topoisomerase 1 inhibitors may be resistant to both drugs...
What are the factors that you would consider for the use of ESA in patients with anemia of CKD with a history of stroke or TIA?
Large clinical trials of ESA have indicated increased stroke risk with these medications with TREAT reporting the highest stroke incidence. In this study, "baseline history of cerebrovascular disease was a strong predictor of experiencing a stroke during follow-up; patients with a history of stroke ...
Would you recommend adjuvant chemotherapy for a Stage II colon cancer patient who has negative ctDNA but presented with obstruction?
I often tell my patients that, where the field of liquid biopsy is at present, we have not too many concerns about the positive ctDNA results. It’s the negative ctDNA results that one has to be careful with.In general, if there’s a strong clinical reason to give adjuvant, I don’t rely on ctDNA to ch...
How would you treat an older patient with B symptoms and biopsy consistent with grade 3 follicular lymphoma but noted to have a PET scan with SUV readings of > 20?
If an adequate biopsy was performed of the most active (high SUV) mass/node and results as follicular grade 3 A, then can treat as you would a follicular lymphoma with BR. I have seen high SUVs with follicular lymphoma. Mir et al., PMID 31961926However, if it is follicular grade 3 B or has high Ki67...
How would you treat an older patient with B symptoms and biopsy consistent with grade 3 follicular lymphoma but noted to have a PET scan with SUV readings of > 20?
If an adequate biopsy was performed of the most active (high SUV) mass/node and results as follicular grade 3 A, then can treat as you would a follicular lymphoma with BR. I have seen high SUVs with follicular lymphoma. Mir et al., PMID 31961926However, if it is follicular grade 3 B or has high Ki67...
When, if ever, would you consider use of nivo/ipi for favorable risk metastatic ccRCC?
I do think about nivo/ipi for a subset of patients with favorable risk disease -- usually younger patients who are shooting for a complete response. In the favorable risk subset of patients in CheckMate 214, the complete responses are higher than even in the intermediate-poor risk. Patients who have...
What are your top takeaways in GU Cancers from ASCO 2025?
Here are the top 3 prostate cancer studies: AMPLITUDE. LBA5006: Attard and colleagues show that the PARP inhibitor niraparib plus abiraterone/prednisone delayed rPFS in men with mHSPC (HR 0.63, p = 0.0001), meaning this is the first ARPI/PARPI successful combination in this hormone-sensitive HRRm se...
What is your first line of therapy for refractory Hodgkin lymphoma in an AYA patient?
Our first approach in this setting is second line chemotherapy with the intention to achieve a complete metabolic remission (by PET) and then an autologous stem cell transplant. Our approach to the transplant includes total lymphoid irradiation followed by a conditioning regimen of Cyclophosphamide,...