Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How, if at all, have you incorporated GLP-1 agonists into your fertility-sparing management of patients with EIN or endometrial cancer?
That is a question that needs to be more clearly defined. We have a project in our endometrial SPORE grant that seeks to answer that question. This project is led by Andrea Hagemann at Washington University. In this project, the effect of weight loss, augmented by GLP1 agonists with weight loss coun...
How are you interpreting the early RASolute 302 trial findings (daraxonrasib) in metastatic PDAC?
Update 6/2/2026: Well, this plenary abstract exceeded my expectations. That p-value! The possibilities for pancreas cancer treatment, it's a dream realized for our patients. Now, we need to keep our eye on the FDA to approve this quickly, and we also need to keep pushing for RAS inhibition in all p...
Would you offer adjuvant chemotherapy to a premenopausal woman with HR+ HER2 negative IDC, T1cN0, with isolated tumor cells, oncotype RS 20, grade 2, with multifocal LVI?
First - isolated tumor cells have no clear impact on prognosis and should NOT be used to alter local or systemic treatment decisions. The TAILORx trial unplanned subgroup suggested a small but real benefit from chemo. However, very few (11%) of premenopausal patients got optimal HRT that included OF...
What approaches can we take to initiate therapy and improve survival rates in patients with HLH?
At our institution, we have comprised a multidisciplinary team to help treat these patients. The team or "HLH task force" as we like to call ourselves is comprised of a clinical immunologist, rheumatologist, dermatologist, critical care physician, hepatologist, BMT attending/hematologist, infectious...
Would you use MammaPrint in patients with triple-negative or HER2-positive breast cancer based on the results from the MINDACT trial?
The MINDACT data from the 2016 NEJM article has a lot of detail, in particular Table 1, which gives the number of subjects in each risk group sorted by clinicopathologic features. There were 638 Her2 positive subjects out of 6693 total, or 9.5%. Of these, 501 (7.5% of total) were ER positive and Her...
What would you offer as adjuvant therapy for a resected stage IIIB adeno NSCLC in a patient who refuses chemotherapy?
Patients with stage III NSCLC are at very high risk for recurrence, and in this situation, I would make sure that your discussions with the patient highlight this clearly. My usual thought is that if a patient can tolerate and recover from lobectomy/resection, then that is a reasonable indication th...
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...
If adjuvant radiation is offered to an elderly patient with H&N SCC s/p Mohs surgery who is planned for multi-stage reconstruction of the defect with plastic surgery, when should adjuvant radiation be started?
Tumor control comes first. If the surgical defect is such that reconstruction is required, it is even more imperative to focus on the above principle, as a recurrence would almost certainly risk ruining the entire collective effort. Vascular flaps could be safely performed post-RT in most cases by s...
How would you manage a young patient with Sjogrens disease with extranodal marginal zone lymphoma involving bilateral parotid glands with bilateral cervical lymphadenopathy?
For patients with low-grade NHLs (e.g., follicular lymphoma, marginal zone lymphoma), staging dictates treatment. If a patient has a localized process (e.g., contiguous stage I-II disease), then a definitive course of RT is typically recommended. The conventional approach is 24-30 Gy, though a dose-...
When do you consider consolidation chest radiation in a patient with stage IV non-small cell carcinoma of the lung who has had good response to systemic therapy?
It's a really great question, and it comes up a lot in our tumor boards and general practice. There are a couple of paradigms that I use to help me think through when and how to do it. I would say the data here for the use of RT is mixed, and either gives you freedom to do a variety of things or giv...