Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Do you ever consider intermittent ADT for metastatic prostate cancer?
In general, I recommend continuous ADT for men with metastatic disease based on the OS difference from the Intergroup 0162 trial. I do agree, however, that this trial was a noninferiority design and the difference is not large, therefore in men with very limited disease who display intolerance to AD...
Why are patients getting enzalutamide s/p prostatectomy not candidates for salvage radiation therapy?
Although there have been other efforts to profile the role of enzalutamide (e.g., SALV-ENZA, Tran et al., PMID 36367998) or other second generation androgen axis inhibitors (e.g., FORMULA-509) in conjunction with salvage RT, EMBARK (Freedland et al., PMID 38320501) was designed to test the efficacy ...
Is the increase in RFS seen with adjuvant atezo/bev in IMbrave050 enough to change practice in resected HCC?
The IMbrave050 showed that the combination atezolizumab/bevacizumab improved recurrence free survival in high risk resected HCC patients with RFS 78% vs 65% at 12 months, HR 0.72 (95% CI 0.56, 0.93), this tapered off at approximately 24 months. This suggests that the combination delayed recurrence a...
What is your strategy for managing immunosuppression in patients with a kidney transplant who develop metastatic cancer?
This is a difficult situation. I presume this question refers to cancers for which there is no option of cure. We always discuss the goals of care and review with the patient and their treating oncologist what the prognosis might be. If chemotherapy or check-point inhibitor treatment is planned we ...
Would you offer adjuvant hormonal therapy for premenopausal woman with positive margin HR+ DCIS after a bilateral mastectomy?
Preventive endocrine therapy, with tamoxifen for premenopausal women, should be offered after breast conserving surgery (BCS) and radiation (RT), as it decreases the risk of future events in the ipsilateral breast and also offers preventive benefit in the contralateral breast. Preventive endocrine t...
How would you approach therapy for a solitary fibrous tumor of the orbit with residual disease (10%) after surgery?
The discussion about the possibility of complete resection, even if it involves orbital exenteration needs to happen since that is the only potentially curative treatment. If surgery is not an option or if it is deemed unacceptable by the patient, SFT is indeed radiosensitive. The discussion of the ...
How would you manage IVF using ovarian stimulation in a woman with a prior estrogen related thrombotic event?
This is a very important question. In general, guidelines do not necessarily cover this very specific area. A couple of important points to think about are that (1) women with a history of VTE provoked in the setting of estrogen therapy – for example, contraceptive use – are advised to undergo pharm...
How would you manage IVF using ovarian stimulation in a woman with a prior estrogen related thrombotic event?
This is a very important question. In general, guidelines do not necessarily cover this very specific area. A couple of important points to think about are that (1) women with a history of VTE provoked in the setting of estrogen therapy – for example, contraceptive use – are advised to undergo pharm...
Do you adjust chemotherapy dose if >=10% change in calculated dose, weight, BSA, or if any of these three parameters are met?
Our institution has a policy of adjusting chemotherapy doses if there is a 10% change in calculated dose. Since some drugs are based on weight and some on BSA, it gets complicated if we stick with one versus the other. Also, this practice aligns with ASCO recommendations.
When do you offer adjuvant chemotherapy after wide-local excision for soft tissue extremity sarcomas?
High risk extremity and superficial trunk STS, AJCC stage 3. Data is more convincing in Sarculator, which projected a risk of recurrence higher than 40%. If resection has already happened, adjuvant XRT has to follow first before adjuvant chemotherapy.