Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How would you manage contralateral neck recurrence <6 mos. following resection and adjuvant CCRT for node positive tongue cancer?
Giving possible curative therapy as it is a local regional recurrence
In patients treated with the KEYNOTE A-18 regimen who later recur, would you rechallenge with immunotherapy again?
Limited data in this clinical scenario. Per A18 (Lorusso et al., PMID 38521086), 32 patients received ICI as post-progression therapy, 25 of whom received Pembro. I am unable to find in the supplements whether those were patients from the placebo arm or from the pembro arm.I think if the patient rec...
Would you be comfortable starting tamoxifen for a HR+ breast cancer patient with a history of early stage endometrial cancer treated via hysterectomy?
I would have no problem putting someone with early endometrial cancer on tamoxifen who had had prior hysterectomy. There is no evidence that tamoxifen would increase the risk of recurrence of the endometrial cancer. In fact, recurrent endometrial cancer is sometimes treated with a combination of tam...
Which chemotherapy should be held while delivering palliative radiation?
Any chemo that is considered a radiosensitizer should be considered as potentially increasing toxicity during palliative RT, and the question of whether to hold these agents should be carefully considered at the very least. This includes but is not limited to: doxorubicin, gemcitabine, taxanes, 5FU,...
What data support the use of continuing GnRH therapy "backbone" in metastatic castration resistant prostate cancer (mCRPC) receiving additional therapies?
The short answer is that ALL phase 3 trials of life-prolonging therapies now approved in mCRPC required ongoing ADT (medical or surgical) and there is not a single positive life-prolonging phase 3 trial that did not do this. Until then our strongest evidence is to follow how these trials were conduc...
How do you approach postoperative radiation for small oral cavity cancers cases with limited risk factors?
LVI is considered a minor risk factor in HNC, similar to PNI, but data regarding its exact prognostic effect and whether it alone deserves adjuvant treatment are scant. For example, a large MSKCC of OC patients found LVI in only 11% of patients, compared with 25% of patients with PNI (Zaromi et al.,...
How do you sequence capecitabine and olaparib, if at all, in patients with BRCA+ TNBC and residual disease after neoadjuvant chemotherapy?
Patients with germline PV in BRCA 1/2 and residual disease following NAC in early TNBC have two options that likely represent standard of care in the adjuvant setting, a) adjuvant capecitabine (CREATE-X, EA1131) and/or b) adjuvant olaparib (NSABP B55). B55 did not allow for any further adjuvant chem...
Are there instances where you can defer on mass spectrometry testing for amyloid typing in Congo Red positive tissue?
This is a great question and one that is not uniform in its answer depending on the clinical situation.Assuming we are talking about at diagnosis here, the short answer is always send Congo red positive bone marrow findings for mass spec typing if there is enough positive protein to dissect and type...
How do you follow pulmonary embolism patients who have completed anticoagulation?
3 months after sustaining an acute PE, I asked the patients if they were back to their pre-PE level of functional capacity. If they are not, i.e. if they remain dyspneic, I get an echocardiogram and a VQ scan. If the echo during the acute PE shows RV strain or evidence of pulmonary hypertension, I r...
In a patient with primary mediastinal seminoma with normalization of biomarkers s/p EPx4 and residual non-FDG avid mass, would you consider resection of residual tumor vs surveillance?
Patients with a primary mediastinal seminoma will have > 90% cure rate with chemo alone, but will ALWAYS have a residual mass. Assuming the initial serum AFP was normal and pathology was definitive that this was ONLY seminoma, we would not even do a PET scan but just observe with serial CT scans, H ...