Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How would you approach treatment for a cT1N0M0 urothelial carcinoma of the ureter, high grade in a non-surgical candidate due to medical comorbidities?
Although there is limited data using radiation therapy or chemo-radiation in UTUC, in a non-surgical candidate, this may be a reasonable approach to consider in selected patients. This would be an extrapolation from the promising data from RTOG 0926, a single arm, phase II trial investigating trimod...
Is it unusual to have isolated LDH elevation and normal HCG and AFP in non-seminomatous germ cell tumor (embryonal carcinoma)?
It's hard to generalize: the details of the case matter. It is not very unusual to have an isolated LDH elevation. LDH is extremely non-specific. 101 different things can make LDH go up and this limits its usefulness as a tumor marker. Elevation of LDH on day 1 of cycle one of first-line chemotherap...
Do you utilize Oncotype DX DCIS score to decide on the need and duration of endocrine therapy in patients with DCIS?
There is not enough data to use Oncotype Dx DCIS score routinely in practice and I personally don’t use it. Certainly, in patients with DCIS who get a simple mastectomy, it has no applicability since mastectomy is the definitive therapy for DCIS. In patients with lumpectomy, adjuvant breast radiatio...
How would you manage a new suspected brain metastasis in a patient with a distant cancer history?
So I think there are some details missing but generally, if there is a suspected brain metastases in a patient with distance cancer history and that biopsy/resection is not feasible, I would consider additional workup including extracranial imaging. If the suspected brain metastases is asymptomatic ...
Do you recommend concurrent or sequential radiation and chemotherapy for margin-positive, node negative NSCLC?
We recently looked at outcomes with sequencing of PORT and chemotherapy in patients with pN2 disease and R0, or pN2 R1/R2 resection in the NCDB (J Clin Oncol 2017 Dec 13:JCO2017744771). This group is not exactly the pN0 patient population that is the focus of this question, however, in the R0 pN2 gr...
Do you regularly incorporate oral cryotherapy in your practice for patients receiving oxaliplatin to decrease the risk of thermal hyperalgesia?
I personally am not opposed if a patient wishes to try it but I also am not a big believer. There are several issues here - the peripheral neuropathy will continue to be an issue overall, this study regressed to the mean over time and it’s a smaller study (although randomized which is very helpful)....
What is your strategy for treating headaches in patients with history of brain tumor?
Not all headaches in patients with brain tumors arise in the context of elevated ICP, but there are other mechanisms (dural irritation, traction on blood vessels, post-craniotomy pain, for example) by which they can be related. If the headache otherwise seems migrainous, I would treat it as migraine...
Is there any advantage to proton beam therapy in a locally recurrent anal carcinoma, which has already been treated with concurrent chemo RT as well as APR for relapse?
Even with a local recurrence, patients’ life expectancy can be relatively long, which often introduces the question of repeating radiation treatment. Although this option must be balanced with the potential toxicities and consequences of re-treatment, the possible morbidity from tumor progression is...
How do you manage incidentally identified pituitary lesions on brain imaging?
Pituitary lesions are among the most common incidentalomas seen on brain MRIs. Various studies cite numbers as high as 10- >30% for pituitary lesions found incidentally on brain imaging, with the higher incidence rates emerging in the era of high-resolution MRIs. In pediatric neurology/neuro-oncolog...
Do you think that home INR monitoring is a feasible option for elderly, frail patients with atrial fibrillation on VKA treatment, given variations in socioeconomic status and access to care?
Whenever possible, I prescribe home INR monitoring with appropriate equipment. This allows me to monitor my patients on a weekly basis, rather than on a monthly basis at best. Unfortunately, insurance reimbursement is not standard for this equipment, and many patients are unable to obtain it. The ab...