Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Has use of PSMA PETCT revealed increased local failures than previously known after definitive prostate EBRT with biochemical failure?
Prior to the advent of PET imaging, the published rates of local recurrence (LR) after definitive RT vary widely in phase III trials from ≈ 1% (e.g., PCS IV) to ≈ 30% (e.g., PROG 9509). The heterogeneity is likely explained by several factors including (1) differences in baseline risk of local recur...
How would you manage a cT4N0 HER2- distal esophageal adenocarcinoma, CPS score 30, with good response to neoadjuvant chemo-RT on PET and residual disease on EGD in a patient who declines surgery?
There's really no good answer here. What one does is predicated largely on how much faith one has in the efficacy of nivolumab.The benefit of adjuvant nivolumab in patients with locally advanced esophageal cancer who underwent trimodality therapy and had residual disease is of course based on the Ch...
Can PRRT be used in a patient with a GI neuroendocrine tumor and estimated GFR of less than 30?
Unfortunately there is no safety data for the use of PRRT in patients with GFR <30 ml/min. A creatinine clearance <50 ml/min is listed only as a relative contraindication by NANETS/SNMI (Hope et al 2020) and ENETS guidelines (Hicks et al 2017). Based on over 2 decades of experience with PRRT, the lo...
What infectious prophylaxis do you use for patients with newly diagnosed multiple myeloma?
Excellent question for sure. In order of controversial nature/lack of evidence/lack of consensus around evidence: 1) Antiviral prophylaxis - I don't think there's any controversy around this, particularly in patients on PIs and/or a CD38 mAb. We do use acyclovir even in patients who have received th...
In what situations, if any, would you recommend NALIRIFOX over FOLFIRINOX for first-line treatment of patients with unresectable pancreatic cancer?
Given the currently available information, I would not use NALIRIFOX instead of mFOLFIRINOX in any situation.My reasons for this are: mFOLFIRINOX has been the standard of care for the treatment of metastatic and unresectable pancreatic cancer in patients who can tolerate this regimen for over a deca...
Would you consider definitive chemoradiation followed by surgery for esophageal adenocarcinoma with a single distant metastatic site?
The management of oligometastatic esophagogastric cancer is a controversial and evolving topic. For many years, our disease management team (DMT) shied away from such an approach, in large part because of the results of the phase III REGATTA study (Fujitani et al., PMID 26822397). This Japanese stud...
What is your approach to managing follicular lymphoma with central nervous system involvement?
Not really an expert on this issue. Fairly uncommon to have a follicular lymphoma-associated CNS disease. Our usual is for high-dose methotrexate, Temodar, and rituximab. Potentially followed by autologous stem cell transplant.
What is your approach to managing follicular lymphoma with central nervous system involvement?
Not really an expert on this issue. Fairly uncommon to have a follicular lymphoma-associated CNS disease. Our usual is for high-dose methotrexate, Temodar, and rituximab. Potentially followed by autologous stem cell transplant.
Is Oncotype testing useful in variant histologies such as micropapillary breast cancer?
I have no idea whether Oncotype testing is predictive of benefit to chemotherapy in micropapillary breast cancer, which is a rare variant. Micropapillary variant tends to worse prognosis and greater degree of nodal positivity in some studies. However, in other studies, the prognosis is similar to in...
Would you change systemic therapy in a patient with SCLC with stable systemic disease but CNS progression?
Since the patient has well-controlled extracranial disease, I would continue lurbinectedin. As the new intracranial lesions are potentially treatable with SRS, I would favor that approach for this patient.