Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Would you omit radiation for an elderly woman with bilateral breast cancers (both early-stage disease and ER+/PR+/HER2 negative) who otherwise meets the criteria for endocrine therapy alone?
Yes. If the patient meets omission criteria on each side individually, then I offer omission to the patient overall as part of shared decision-making, although it is conceivable that the absolute benefit of radiation is doubled in this scenario. As usual, this assumes the patient will be compliant w...
What are your top takeaways in Head & Neck Cancers from ASCO 2025?
The phase 3 KEYNOTE-689 and the phase 3 NIVOPOSTOP. A key distinction is that KEYNOTE-689 incorporated both neoadjuvant and adjuvant immunotherapy, while NIVOPOSTOP restricted immunotherapy to the adjuvant phase and specifically targeted patients with high-risk features (+ margins and ECS) post-surg...
Are any centers routinely using 55 Gy in 20 fractions with chemotherapy for definitive treatment of head and neck cancer following presentation of the HYPNO study?
I would not consider 55 Gy in 20 fractions a standard approach. The comparator arm was not standard practice in the US (66 Gy in 33 fractions with 5 weekly cycles of cisplatin at 35 mg/m2). Both the total RT dose (66 Gy < 70 Gy) and the total cisplatin dose (cumulative dose 175 mg/m2, less than the ...
How do you treat an isolated in-transit recurrence of melanoma without evidence of clinical nodal involvement in a patient with a history of previously resected primary melanoma?
TVEC is an option.I could also agree on NADINA or pembrolizumab, depending on the patient's other comorbidities.Resection is also a possibility, but then would need a discussion of adjuvant therapy.Indeed, there are many options, and none has been studied in detail.I like neoadjuvant, as it gives an...
Is there a role for resection of the cutaneous primary in a patient on dual-agent immunotherapy for metastatic melanoma?
Yes. The location and size (width, length) should be noted. The patient should first be treated with dual ICI. If the patient with metastatic melanoma, who has the primary intact, undergoes successful dual ICI therapy and has a documented CR, near CR, or excellent PR, which is typically noted within...
Does receipt of chemoimmunotherapy for LS-SCLC impact your recommendation for PCI?
Historic data showed that the addition of PCI for patients with limited-stage small cell lung cancer showing response after chemoradiotherapy improves overall survival and decreases brain failure rates by about 50%. Recently, the addition of consolidation immunotherapy after concurrent chemoradiothe...
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?
This is certainly not an easy question. Assuming that the patient doesn't have an actionable targetable mutation, two important things that may be helpful to know in such cases are disease behavior and the status of disease in the brain. If the disease is behaving aggressively, we SHOULD ALWAYS rule...
Would you use bevacizumab in a patient with advanced HCC and multiple large esophageal varices that have not been endosopically intervened upon?
Large varices should be treated endoscopically. I would avoid using Atezo/bev in a patient who has not had adequate treatment of their varices as there is a real risk of bleeding with bev in this setting.
What is your platelet cutoff for atezolizumab + bevacizumab in HCC in the absence of bleeding (variceal or otherwise)?
The platelet eligibility for IMBrave150 was 75K, I believe. Eligibility in the original SHARP trial was 60K, so I often consider somewhere around 60K. Although if truly no varices on EGD and no history of bleeding, I might consider down to 50K. Lower than that, I would probably think single agent ch...
Should we consider radiation therapy for patients with N2 EGFRm NSCLC who will receive osimertinib, though RT was excluded on ADAURA?
For an EGFR-mutant N2 disease, we favor adjuvant chemotherapy (OS benefit) and/or adjuvant TKI based on ADAURA trial (DFS survival). The only prospective data regarding the use of adjuvant radiotherapy comes from a phase III trial, Lung Adjuvant Radiotherapy Trial (Lung-ART), where patients were ran...