Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Do you offer RT both to the prostate and synchronous oligometastases in de novo oligometastatic prostate cancer?
We do not yet have good evidence to tell us whether or when we should offer metastasis-directed therapy (MDT) for de novo oligometastatic prostate cancer. ORIOLE (like STOMP) was conducted in the recurrent setting. Those trials showed that MDT could delay progression and possibly allow a delay in th...
Do you add ADT to RT for a patient with intermediate-risk prostate cancer with discordant Decipher and ArteraAI results?
This will be a long response to try to provide transparency to these tests from what I know as a researcher and clinician. I also clinically see this situation frequently. We have made incredible progress in developing biomarkers in prostate cancer, but it is important to know that no single test is...
In which patients will you consider the use of adjuvant pertuzumab for HER2 positive early stage breast cancer?
The benefit of adding pertuzumab to a trastuzumab-based regimen is quite small (0.9% at 3 years, 1.8% in those with involved LNs). This will not change my practice for most patients. Certainly for a patient with multiple involved nodes and ER- disease, the addition of pertuzumab will become a long d...
Is it reasonable to treat a solitary plasmacytoma of the lung parenchyma with SBRT?
I have only treated one patient with solitary plasmacytoma of the lung over the past 15 years of doing lung SBRT. It is an extremely rare and unusual disease presentation for myeloma. Given the radiosensitivity of myeloma, I opted for 30 Gy in 5 fractions, which resulted in a completed response in t...
Is it necessary to prescribe a steroid taper after two weeks of high-dose prednisone (60 mg daily)?
Interesting question. Not being an endocrinologist, I don't have the expertise to advise but the reference below makes the statement that even short-term steroids can be an issue. I suspect that if you have to stop abruptly from 60 mg daily for 2 weeks, it would probably be fine in most instances bu...
Is it necessary to prescribe a steroid taper after two weeks of high-dose prednisone (60 mg daily)?
Interesting question. Not being an endocrinologist, I don't have the expertise to advise but the reference below makes the statement that even short-term steroids can be an issue. I suspect that if you have to stop abruptly from 60 mg daily for 2 weeks, it would probably be fine in most instances bu...
Are you altering your use of immune checkpoint inhibitors given the risk of immune-related pneumonitis and the COVID-19 outbreak?
The management of advanced cancer patients has gotten even more complex with the COVID-19 pandemic. In general, providers are trying to keep patients away from the hospital/clinic as much as possible, and avoiding regimens with greater toxicity if there are suitable less toxic alternatives. Whether ...
How are you modifying your current sarcoma-directed therapy in the setting of the COVID-19 pandemic?
Here are the guidelines at Fox Chase Cancer Center by Margaret von Mehren MD, @Dr. First Last , Jeffrey Farma MD, Sanjay Reddy MD, John Abraham, MD, and Stephanie Greco, MD I. Management of STS during COVID-19 Pandemic: During the current pandemic, care will need to be changed to allow for hospitals...
What are your top takeaways in GI Cancers from ESMO 2025?
1. MATTERHORN StudyThe global phase III MATTERHORN trial enrolled 474 patients with resectable gastric or gastroesophageal junction adenocarcinoma, randomized to receive FLOT alone or FLOT plus durvalumab. The primary endpoint, event-free survival (EFS), was previously reported as positive. Adding d...
For patients with EGFR mutation positive NSCLC who progress on first line TKI without actionable resistance mechanisms, would you consider chemotherapy + targeted therapy as a second line option, or chemotherapy +/- immunotherapy?
Although the question assumes no actionable changes in the lung cancer, I do refer you to an excellent review of this topic, published last September (Piper-Vallillo et al., PMID 32552277), which included a table listing twenty-five open clinical trials for patients who have developed progression af...