Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How can you adjust neoadjuvant or adjuvant platinum based chemotherapy for stage Stage II-III non-small cell lung cancer in patients with significant renal insufficiency?
This is a great question as to one of our key responsibilities as practicing oncologists. Properly tailoring treatment - in this example chemotherapy to our patient’s needs – recognizing particular co-morbidities of concern, his/her willingness to tolerate side effects, and striking the right balanc...
Are there any circumstances where you recommend early institution of systemic therapy for patients with solitary plasmacytoma?
Assuming a true solitary plasmacytoma with no bone marrow involvement, I do not recommend systemic therapy in almost all circumstances. However, there are times when the location of a solitary plasmacytoma precludes definitive/curative dose radiation; even with surgical resection, I would favor syst...
What stroke symptoms would lead you to avoid using oxaliplatin in a patient with metastatic colon cancer and a recent stroke?
This is not a rare situation, given colorectal cancer in general is a disease with a median age of 66 in men and 69 in women at diagnosis. If the patient is considered to be a good candidate for systemic therapy, which means the patient must recover from the recent stroke reasonably well with well-p...
How would you manage recurrent anal SCC after chemoradiation, with positive margins after resection?
There aren't many details given about the recurrence. If it is a local recurrence, I would suggest repeat attempt at surgery be considered. If it is a distal recurrence, one could consider carboplatin and paclitaxel chemotherapy (based off of this InterAAct trial). Increasingly, I am favoring checkp...
Would you offer adjuvant endocrine therapy to a patient with a history of ER-positive DCIS, s/p bilateral mastectomy, now with chest wall recurrence of DCIS four years later?
This is an unusual case, and I wonder how she presented initially and with the recurrence, and if she has a history of exposure to radiation. In addition, a pathology second opinion to confirm the lack of an invasive component is in order. Theoretically, close to all of the breast tissue should have...
Would you offer definitive radiotherapy for prostate cancer (or another solid organ malignancy) to a patient on maintenance Rituximab for lymphoma?
Good question and a somewhat increasingly common issue in the general sense of patients with overlapping hematologic and prostate malignancies. For starters, I would think hard about the risk group of this patient and competing risks. If this patient has an aggressive or relapsed lymphoma with favor...
In cT4aN0 triple negative breast cancer would you still recommend PMRT if pCR, ypT0N0(sn), after neoadj chemo is achieved?
This case includes several distinct issues. The first is the accuracy of the initial staging. The AJCC 8th edition definition of clinical stage T4a is: "T4a is extension to the chest wall. Adherence/invasion to the pectoralis muscle is NOT extension to the chest wall and is not categorized as T4." E...
What adverse events would make you switch off nivo + AVD therapy and to what second line therapy in patients with Hodgkin Lymphoma?
The question of how to handle severe IRAEs when using the N+AVD regimen is an important one. First, of course, is to hold CPI therapy, empirically treat as indicated to avoid ongoing or worsening organ injury, and concurrently ensure that there is no other cause for the observed event(s). But if you...
What adverse events would make you switch off nivo + AVD therapy and to what second line therapy in patients with Hodgkin Lymphoma?
The question of how to handle severe IRAEs when using the N+AVD regimen is an important one. First, of course, is to hold CPI therapy, empirically treat as indicated to avoid ongoing or worsening organ injury, and concurrently ensure that there is no other cause for the observed event(s). But if you...
When do you recommend induction chemotherapy prior to concurrent chemoradiotherapy for locally advanced NSCLC?
I rarely recommend induction chemotherapy prior to definitive concurrent chemoradiation. This is because two randomized studies, LAMP (PMID 16087941) and CALGB 39801 (PMID 17404369) showed no survival benefit and added toxicity with induction chemotherapy compared to concurrent chemoradiotherapy alo...