Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How would you approach treatment for a pre-menopausal patient with PR-positive, ER-negative, HER2-negative cT1c N1 breast cancer?
The prevalence of ER- PR+ HER2- breast cancer is relatively low and probably ranges from about 0-8%, with concerns about technical errors in HR status determination by IHC often being expressed in this instance. Because of this, I would consider repeat receptor testing at some point (an additional b...
How would you approach adjuvant therapy for a patient with resected T4N1 high grade large cell neuroendocrine tumor of the cecum with adenocarcinoma component?
However the diagnosis of mixed neuroendocrine-non-neuroendocrine neoplasm (MiNEN) requires that each component (NEC and adenocarcinoma) exceeds 30%, I will make sure with pathology again this case is not MiNEN. For most patients with apparently localized GEP NECs, or MiNEN we should proceed with adj...
What is your standard diagnostic workup to confirm GVHD in a patient post-BMT with skin rash and jaundice?
I assume there is no diarrhea, so sigmoidoscopy would not be helpful. Gut and liver pathology are useful. Skin biopsy is less helpful. It can be fairly nonspecific, but we do it to rule out other diagnoses that have more definitive pathology. Ultimately, it is a clinical diagnosis. Liver biopsy woul...
What is your standard diagnostic workup to confirm GVHD in a patient post-BMT with skin rash and jaundice?
I assume there is no diarrhea, so sigmoidoscopy would not be helpful. Gut and liver pathology are useful. Skin biopsy is less helpful. It can be fairly nonspecific, but we do it to rule out other diagnoses that have more definitive pathology. Ultimately, it is a clinical diagnosis. Liver biopsy woul...
In a patient with very advanced head and neck cancer treated with induction chemotherapy and then definitive radiation do you recommend adding concurrent chemotherapy with the radiation?
Sequential chemotherapy does not provide a survival benefit over definitive chemoradiation. [1], [2], [3]. Hence, reasons to consider induction chemotherapy are for local control of disease and to delay the onset of distant metastases. Additionally, there are concerns for increased toxicity and dela...
How does triple-negative status influence your management of ET?
This is a fantastic question! First, I would ensure that the patient has triple negative ET (or pre-fibrotic PMF) and not a secondary cause for thrombocytosis. This requires a bone marrow biopsy and a careful examination with hematopathology to ensure there are morphologic features consistent with a...
How does triple-negative status influence your management of ET?
This is a fantastic question! First, I would ensure that the patient has triple negative ET (or pre-fibrotic PMF) and not a secondary cause for thrombocytosis. This requires a bone marrow biopsy and a careful examination with hematopathology to ensure there are morphologic features consistent with a...
How would you manage a middle thoracic esophageal squamous cell carcinoma (tumor is 25-30 cm from carina) with a positive supra-clavicular lymph node?
For Proximal/Mid Thoracic ESCA, supraclavicular node is considered a regional node, and therefore part of the AJCC N1-N3 staging system, and should be managed with locoregional treatment, using preoperative or definitive chemoradiation, to 50-50.4 Gy in 2.0/1.8 Gy per fraction. The node could be tre...
What dose/fractionation do you like to use for palliation of bulky LAD from CLL/SLL?
I have treated patients with bulky mass(es) - mostly parotids of recent. Bulky mass(es) -> I like either 400cGy x1 but most use 200cGy x2 (mostly used by me) -> (Electrons for structures like the parotid, but photons for deeper stuff.) For example, when I treated a few parotids glands, they were swo...
What clinical parameters determine when you treat a large HCC lesion with ablative radiation vs Y-90?
Based on 3 negative randomized trials that have compared Y-90 to relatively inactive targeted therapy (Sorafenib), Y-90 has no evidence-based role in the treatment of HCC. In fact, systemic therapies have improved and 3 regimens have shown a survival benefit for locally advanced and metastatic HCC. ...