Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
When do you consider testing for dihydropyrimidine dehydrogenase (DPD) for patients prior to treatment with 5-FU/capecitabine?
Happy to address this question! It is my practice to test for DPD deficiency in all patients who will receive a first treatment with a fluoropyrimidine agent (5-FU or capecitabine). My objective in doing this is to avoid infrequent but readily avoidable severe toxicities and deaths related to DPD de...
How do you approach EGFR mutated NSCLC with isolated progression in the chest who is planned for a course of radiation at least 3-4 weeks?
This is an interesting question without a clear answer. There are two competing risks associated with either decision. The risk of continuing osimertinib while radiating chest disease is clearly that of pneumonitis with the overlapping risks from radiation and osimeritinib. The risk of holding osime...
When utilizing KN-A18 protocol, how do you best address symptoms of colitis/cystitis?
I have now anecdotally heard of 2 patients not completing EBRT/Brachytherapy due to the combined AI colitis picture superimposed on a traditional chemoRT GI toxicity. While there were reasons for patients to not complete pre-ICI, those reasons were generally not because of GI toxicity. The main thin...
Should women with adequately debulked ovarian cancer receive bevacizumab with chemotherapy in the adjuvant setting?
The answer to this question is definitively NO.Two large, definitive studies (ICON-7 and GOG218 – including over 3400 patient combined) evaluated the impact of adjuvant chemotherapy with concurrent + maintenance bevacizumab. Analysis of mature data from ICON-7 demonstrated a significant overall surv...
What is the optimal frequency and duration of post-operative radiological surveillance following resection of a solitary fibrous tumor?
Partly depends on the subset of SFT. The classic variant is low-grade, indolent clinical behavior and can recur late (several years later) requiring (maybe less frequent) but long-term follow-up for 10 years or even beyond. The malignant SFTs have a shorter natural history and typical sarcoma follow...
Is there a role for DOAC use for patients with unprovoked PE, that have had recent sleeve gastrectomy with duodenal bypass?
Alterations in the gastrointestinal (GI) tract following bariatric surgery, as well as altered or reduced oral intake, have the potential to impair the absorption of both DOACs and VKAs in the acute setting. DOACs are absorbed in the upper GI tract, which is altered by the most common bariatric surg...
Is there a role for DOAC use for patients with unprovoked PE, that have had recent sleeve gastrectomy with duodenal bypass?
Alterations in the gastrointestinal (GI) tract following bariatric surgery, as well as altered or reduced oral intake, have the potential to impair the absorption of both DOACs and VKAs in the acute setting. DOACs are absorbed in the upper GI tract, which is altered by the most common bariatric surg...
How do you treat metastatic RCC with fumarate hydratase mutation (Hereditary Leiomyomatosis and RCC [HLRCC])?
For patients with newly diagnosed brain metastases without a history of seizure activity, do you routinely start anti-seizure medication?
This is a common clinical question that has been repeatedly explored in meta-analyses and clinical guidelines. Consistently, there's no evidence to support primary prophylaxis for seizures in patients with brain tumors including brain metastases. In summary, the data does not support the routine use...
What is the role of surveillance imaging after first line therapy in patients with aggressive lymphomas?
Most relapses from complete remission in patients with diffuse large B-cell lymphoma are symptomatic. I am aware of no evidence that surveillance leads to the diagnosis of asymptomatic relapses that are more likely to respond to salvage therapy. My own concern about frequent surveillance is the adve...