Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Would you offer a palliative or more aggressive course of radiation therapy for a symptomatic isolated supraclavicular recurrence of a squamous cell carcinoma of the esophagus?
Such early disease progression suggests there was likely occult involvement of the supraclavicular lymph node at the time of initial diagnosis. My decisions on management would hinge upon the extent of initial CRT field.If the supraclavicular lymph node was in field, I would favor a systemic treatme...
Would you recommend VIP x 4 cycles over EP x 4 cycles in a patient with good risk Stage IIIB seminoma but an elevated LDH over 5x upper limit of normal with a 20 pack year smoking history?
So I would not automatically rule out BEP X 3 just because he has a history of smoking. I would look at his age and renal function. If he is younger than 40-45 with good renal function and normal diffusion capacity, I would give him BEP X 3 and check him with each dose of bleo regarding the history ...
Given RADICALS-HD, are you completing 24 mo vs 6 mo of ADT with XRT following RP?
Initial: We know 2 years of ADT works. Adding to the classic RTOG 9601, RADICALS-HD demonstrated an improvement in the primary and clinically-relevant endpoint of MFS.Who should be offered 2 years is a more nuanced question. I rely heavily on the PSA to guide as I am influenced by the significant in...
Given the improved ability to spare heart, kidney and liver, should IMRT be the standard of care for gastric MALT lymphoma (despite the low dose needed to effectively treat these patients)?
Gastric MALT lymphoma is a tantalizing disease to utilize IMRT. The target is typically irregularly shaped and surrounded by critical normal structures, including the heart, liver, and kidneys. The standard dose for gastric MALT lymphoma is 30 Gy. Thus, one needs to be mindful of dose to all of thes...
For essential thrombocythemia with an indication for aspirin, would you defer therapy if they are on celecoxib?
For an individual with a diagnosis of ET and an indication for aspirin (81-100 mg PO daily), the concurrent use of the COX-2 inhibitor celecoxib would not lead me to hold aspirin. Available studies do not suggest that Celecoxib interferes with the antiplatelet effects of low-dose aspirin in a signif...
For essential thrombocythemia with an indication for aspirin, would you defer therapy if they are on celecoxib?
For an individual with a diagnosis of ET and an indication for aspirin (81-100 mg PO daily), the concurrent use of the COX-2 inhibitor celecoxib would not lead me to hold aspirin. Available studies do not suggest that Celecoxib interferes with the antiplatelet effects of low-dose aspirin in a signif...
Do you screen children with sickle cell disease for silent cerebral infarcts?
We screen children with sickle cell disease for SCIs at our center. This is because data suggest that silent cerebral infarcts (SCIs) are much more common than overt stroke and the long-term negative impacts of SCIs are significant. There are also treatments (e.g., chronic transfusion and stem cell ...
What is your preferred management for renal artery thrombosis causing renal infarct of unclear etiology?
This is a rare, under-recognized, and clinically challenging situation that has been debated for years, primarily because it falls within an evidence “gray-zone.” When evidence is lacking, opinions are abundant, and practice variations are substantial. In general, it is crucial to distinguish betwee...
What are your top takeaways in Thoracic Cancers from ASCO 2024?
ADRIATIC – The addition of consolidation durvalumab after chemo/RT for people with limited-stage SCLC resulted in a 10% improvement in 3-year overall survival, which hopefully means an equivalent improvement in cure rate. Importantly, unlike many trials that are now presented way too early, this on...
Based on the results of CALGB 80803, would you consider induction and/or concurrent FOLFOX in neoadjuvant treatment of esophageal adenocarcinoma?
Great question. The CROSS regimen has been our standard for resectable GE junction and esophagus adenocarcinomas, but the data from the CALGB 80803 study are compelling.For some patients with questionable disease resectability, usually due to extensive nodal involvement, we have been giving “inducti...