Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
In a female patient in her 50s with ovarian cancer who developed a whole-body rash and lip swelling 7 days after her first cycle of carboplatin, paclitaxel, and bevacizumab, how would you proceed with pretreatment for cycle 2, assuming this was a delayed reaction to carboplatin or paclitaxel?
It is very important to characterize any delayed rash after treatment with its timing, morphology, severity, and whether features of a severe cutaneous adverse reaction are present. A benign delayed rash is the most common scenario and can generally be treated with symptomatic management and enhance...
How would you treat a patient with stage IE gastric MALT lymphoma with negative testing for H. pylori?
Standard of care treatment in these patients mostly includes local radiotherapy. You need to be certain that the patient is truly HP-negative; the gold standard for this is negative histopathology for HP. In patients with negative HP histology, you should still rule out HP with non-invasive measures...
How would you treat a patient with stage IE gastric MALT lymphoma with negative testing for H. pylori?
Standard of care treatment in these patients mostly includes local radiotherapy. You need to be certain that the patient is truly HP-negative; the gold standard for this is negative histopathology for HP. In patients with negative HP histology, you should still rule out HP with non-invasive measures...
In a patient with metastatic prostate cancer on abiraterone planning to start Radium-223, what is the minimum interval between the last dose of abiraterone and the first dose of Radium?
Update, May 16, 2026. The context of the question changes based on recently published data. These include the safety of combining an androgen receptor pathway inhibitor (ARPI) with Ra-223 and the utility of this approach in the evolving practice of metastatic prostate cancer.Abiraterone has a half-l...
Would you withhold immunotherapy for ES-SCLC during the COVID-19 pandemic?
Risks of COVID-19 infection and severe pneumonia seem to be higher in our patients with lung cancer. This is fairly early data and some of the patients included in those analyses were not receiving any active therapy. This suggests that at least some of the risk is simply frequent visits to the canc...
Is there any consensus or guidance on how to manage germ cell tumor patients in the COVID-19 era?
Germ Cell Tumor Management in face of SARS-CoV-2: Safe, Rational Modifications to Standard GCT Practice to Protect Public Health, GCT Outcomes, GCT Patients, and Health Systems. This bulletin has been produced by a concerned group of international experts in germ cell tumors, has not undergone exten...
How are you deciding between T-DXd/pertuzumab and THP> HP/tucatinib in patients with metastatic HER2+ breast cancer?
I am reserving HP/tucatinib to the maintenance setting (after 1L THP, as was studied in HER2CLIMB-05, but also will plan to offer it as maintenance after 1L T-DXd/P in patients who experience cumulative toxicity on T-DXd/P and need to stop). I would tend to offer HP/tucatinib maintenance to those wi...
How would you manage the side effects/toxicities (e.g., pain, swelling, erythema) of adjuvant EBRT to the ear for cutaneous SCC?
I have had a few patients experience acute pain in the ear canal, probably from inflammation, wet desquamation, and bacterial overgrowth. Ciprodex Otic drops x 7-10 days have been helpful.
Would you offer chemotherapy to an elderly patient with MSI-H stage 3 colon cancer who cannot tolerate oxaliplatin?
The current NCCN guidelines already incorporated the ATOMIC study data and added CAPOX or FOLFOX with atezolimumab in addition to CAPOX or FOLFOX as preferred regimens for resected dMMR stage III colon cancer, while still listing single-agent fluoropyrimidine as an option.The interesting part to me ...
Would you give a PARP inhibitor, and at what dose, to a patient with end-stage renal disease on hemodialysis after completion of 6 cycles of carboplatin and paclitaxel for advanced ovarian cancer?
This is an interesting question, for which I don't have a quick answer.When it comes to PARP inhibitors (PARPi), there is compelling data for its use as maintenance therapy as well as recurrent treatment. The article by Kurnit et al., is a nice summary of the data available supporting PARPi use (Kur...