Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
When would you consider first line FOLFOXIRI + Bevacizumab for metastatic colon cancer?
The phase III TRIBE study published in 2015 reported first line FOLFOXIRI with bevacizumab treatment had overall survival (OS) benefit compared with FOLFIRI/bevacizumab as first line treatment (29.8 months vs. 25.8 months, HR 0.80, p=0.03) (Cremolini et al., Lancet Oncol 2015). FOLFOXIRI/bevacizumab...
Would you consider using tamoxifen in ER-negative DCIS?
In the placebo-controlled NSABP-B24 trial, tamoxifen reduced the risk of ipsilateral and contralateral second events by 30% and 52%, respectively, when added to BCS and radiation. In a reanalysis of a subset of participants with estrogen receptor expression information, this benefit was most apparen...
What is the preferred agent for metastatic male breast cancer patient who progresses on tamoxifen and is not a candidate for chemotherapy?
This is luckily not a common scenario. Metastatic breast cancer in men is quite unusual in a typical practice, primarily because the disease is rare to begin with and we would most often see men with non-metastatic disease.Of course, the majority of breast cancers in men are ER-positive, more than w...
Should BED or EQD2 be used when deciding on a fractionation scheme for breast cancer radiation, and should tumor or normal tissue be prioritized in this consideration?
I feel, with many prospective randomized data, we are beyond looking at EQ2 dose for deciding fractionation. We follow the below rationale/pathway in our practice. Is biology suitable for PBI or not? (If suitable then plan for 30 Gy in 5 fractions like Italian data) Biology is suitable for PBI but ...
How do you sequence abiraterone and enzalutamide in metastatic, castrate-resistant prostate cancer?
In my experience, abiraterone is better tolerated than enzalutamide. The main difference is fatigue. Quality of life seems no different to most of my patients when I add abiraterone to a GnRH agonist. However, patients frequently complain of substantially increased fatigue with the addition of enzal...
What are your current recommendations for treatment of symptomatic splenomegaly in the setting of myelofibrosis when splenectomy is not an option?
I use low dose, typically 50cGy per fraction for 4-6 fractions, done in 2 fractions per week; need to check platelets each week during course.
What is your experience with Gelclair for oral mucositis during head & neck radiotherapy?
I used Gelclair for my patients regularly till a few years ago. However, I did not find a significant difference in the rates of mucositis among those who did and did not use this product. That is my anecdotal experience and I would be curious to hear other thoughts from those who are routinely reco...
How would you treat a patient with a granular cell tumor of the breast with positive margins following excision?
This is a rare diagnosis, and recurrence has rarely been reported with incomplete excision. However, positive margins alone may not be an indication to re-resect benign granular cell tumor. MDTB discussion is key here. Reports suggest that the long-term prognosis is excellent even with positive marg...
How do you treat SNUC?
There’s no standard treatment. Suitable for gross total resection: surgery and postop RT and concomitant chemo.Not suitable for GTR: chemo RT or induction chemo and reevaluate for surgery and postop RT chemo.
If using GCSF with mFOLFIRINOX, would you ever use it during day 1?
Assuming you are talking about a pegylated GCSF product, we give it on day 4 of this regimen (the day after 5-FU pump ends). We have no problems with reimbursement for that (places the drug 11 days prior to the next dose). I would not be comfortable with a day 1 delivery.