Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How would you manage a cardiac metastasis from Merkel cell carcinoma?
I would first determine the extent of metastases and carefully determine the extent of the tumor in the heart (usually with cardiac MRI). I would also discuss the threat of the tumor to the heart with a cardiologist (if possible). If extensive metastases were present, I would suggest starting with i...
In which scenarios would you consider adjuvant chemotherapy for a patient with T1a N0 triple negative breast cancer?
This is indeed a tough situation and one that we may see more and more as our screening techniques keep getting better.I do consider giving adjuvant chemotherapy for T1ab TNBC and will discuss this option with my patients based on a few factors. Multiple retrospective studies have shown that the DFS...
What adjuvant therapy do you recommend for stage III colon cancer patients unable to tolerate 5FU regardless of modality/dose reduction?
There is no high-quality evidence to support adjuvant chemotherapy for colorectal cancer with a non-fluoropyrimidine regimen. For patients at high risk for colon cancer recurrence, effort should be taken to find a dose or mode of fluoropyrimidine administration that is feasible. For instance, bolus ...
Do you still order mpMRI for staging of prostate cancer in addition to PET-PSMA?
Yes, I still think the prostate MRI adds valuable information for target delineation and local staging. This position is consistent with a recent poll of GU specialists where about 90% of respondents believed that a prostate MRI was still necessary after a PET/CT (Gillessen et al., PMID 35450732).My...
With the CANOVA results in mind, would you continue using venetoclax in patients with multiple myeloma with t(11;14)?
TL;DR - I will still be using venetoclax for t(11;14) myeloma in the way that I have been doing so for some time, which is in combination with other active myeloma agents. I prefer venetoclax 400 mg daily, in combination with either carfilzomib 56 mg/m2 weekly or daratumumab SQ.Now the long version:...
How do you treat unresectable localized desmoid tumor?
Based on the NEJM paper, I use sorafenib. Standard of care is observation unless there is pain or a medical reason to treat.
What are your top takeaways in Gyn Cancers from ASCO 2024?
ASCO 2024 was a quiet year for the gynecological cancer community without too many fireworks. For the radiation oncologists, there were very few positive studies. I will highlight a few important ones 1. Oral abstract #5504 was on “Adjuvant chemotherapy following concurrent chemoradiation (CRT) in p...
How do you manage surveillance imaging for patients with metastatic castration-resistant prostate cancer?
Outside of trials - for SOC patients, I'll usually get imaging around treatment PSA nadir (understanding some of the changes in bone may lag PSA responses). Then, will re-image based on consistent/significant PSA rise or new symptoms. I try to adhere to working group radiographic criteria for SOC pa...
Given the HELEN-006 trial results, under what circumstances, if any, would you consider de-escalated neoadjuvant therapy in HER2-positive breast cancer?
The phase III HELEN-006 trial of abraxane/trastuzumab/pertuzumab (AHP) vs TCHP was first presented with positive results at SABCS 2023, then at AACR 2024, and finally published fully in January 2025 in the Lancet. To summarize the findings, the Lancet 2025 article documented that in this randomized ...
How do you incorporate ctDNA in the management of metastatic breast cancer?
I do use ctDNA molecular profiling assays to detect actionable mutations or for trial matching fairly regularly in my metastatic patients. As for ctDNA tracking tests like Signatera, I would consider their use mainly when routine in-house tumor markers like CA15-3, 27-29, CEA do not correlate well w...