Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How would you empirically manage a large sellar/suprasellar mass with encasement of the right cavernous and terminal internal carotid arteries?
Knowing the histology of the mass would really help in creating more accurate treatment recommendations. A biopsy of a sellar mass is usually accomplished by an endonasal-endoscopic transsphenoidal approach utilizing the expertise of an ENT surgeon and a skull-base neurosurgeon. However, in this cas...
What is your preferred second line therapy for patients with metastatic large cell neuroendocrine carcinoma of the lung after progression on first line chemo-immunotherapy?
Let's start by backtracking to the original treatment recommendation. Since large cell neuroendocrine carcinomas (LCNEC) of the lung can harbor mutations in EGFR or BRAF or even ALK rearrangements, next generation sequencing is appropriate for patients with advanced disease.Assuming no targetable al...
Does Decipher provide any additional value in determining whether patients with metastatic hormone sensitive prostate cancer should receive chemotherapy?
Docetaxel has been part of the treatment paradigm for metastatic androgen pathway inhibitor-sensitive prostate cancer since the CHAARTED and STAMPEDE trials showed its value in addition to standard ADT, particularly in patients with "high volume" disease based on clinical features/lesion number from...
Is it reasonable to offer observation with MRI rather than immediate PCI for patients with limited stage SCLC?
This is an important question with implications for both overall survival (OS) and quality of life (QOL) where level-1 evidence is currently lacking. It is also the subject of an ongoing phase 3 trial (SWOG S1827/Maverick) that randomizes patients with limited-stage (LS) and extensive-stage (ES) SCL...
For patients with locally advanced EBV-associated nasopharyngeal carcinoma treated with induction gem/cis, what concurrent chemo regimen and scheduling do you typically use during radiotherapy?
Cis/gem induction is based on the paper by Zhang et al., PMID 31150573. They used 100 mg/m² every 3 weeks of cis concurrent. ~ 40% received 3 cycles, 50% 2, and 10% 1. As many have in our concurrent scenarios for HN CA, our medical oncologists prefer the weekly 40 mg/m². There remains no clear 2nd l...
Would you consider adding encorafenib + cetuximab to adjuvant mFOLFOX for a patient with oligometastatic colon cancer with BRAF V600E mutation s/p metastasectomy and primary resection given the data from the BREAKWATER trial?
This is a compelling question, and I agree with many of the points made by the other respondents. In a patient with metastatic, completely resected BRAF-mutated colon cancer, I would consider using a ctDNA minimal residual disease assay (such as Signatera) to inform decision making. If the patient i...
Based on the recent IRIS-A trial presented at ASCO 2026, would adjuvant capecitabine plus trastuzumab be a reasonable consideration for a premenopausal patient with a unifocal, microinvasive (0.7 mm), ER/PR-positive, HER2-positive invasive ductal carcinoma (pT1miN0)?
Based on prior retrospective experience that compared outcomes of patients with small, node-negative HER2-positive breast cancer based on whether or not such patients received adjuvant systemic anti-HER2 +/- chemotherapy (summarized by our group in a review article - Johnson et al., PMID 35389302), ...
Would you consider weekly low dose decitabine and weekly venetoclax (metronomic dosing) in frail patients with high-risk MDS?
I find the metronomic dosing regimen of decitabine + venetoclax in high-risk myeloid malignancies (particularly TP53-mutated malignancies) very intriguing but have used the regimen sparingly thus far in the absence of randomized data supporting its use.When thinking about higher-risk MDS, we have da...
Under what circumstances would you pursue completion ALND in a patient with multiple positive sentinel nodes after breast-conserving surgery?
For clinical/imaging node-negative disease with 1-2 positive nodes, now there are 7 plus clinical studies (ACOSOG Z0011, AMAROS, OTOASOR, SENOMAC, IBCSG 23-01, AATRM, SINODAR-ONE) which have shown no difference in axillary recurrence, DFS with dissection, but higher lymphedema as expected. The most ...
How do you explain the use of an AI scribe to patients the first time it is used in their care?
I use an AI scribe in my outpatient clinic, and around 90–95% of my patients agree to it. I obtain consent at the start of each visit and make it clear that it's completely optional—that they can say no at the start or change their mind at any point in the visit, with no impact on their care. I also...