Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How have the results of RTOG 1112 influenced your opinion of Y90 and other IR ablative strategies vs SBRT for HCC not amenable to surgery?
My opinion has changed to a fact with RTOG/NRG 1112 (NCT01730937). RTOG/NRG 1112 now provides definitive evidence that treatment of the entire tumor with an adequate dose of radiation has a survival benefit in patients who are TACE refractory or have macrovascular invasion. The controversy now is wh...
When do you consider using ALK targeted systemic therapy in lieu of WBRT or SRS for patients with metastatic ALK-positive NSCLC?
The development of crizotinib in ALK positive patients led to incredible control rates systemically, but as is now well known, less ability to control CNS disease. When crizotinib was the sole FDA approved ALK directed therapy, this led to the concept of "treatment beyond progression" such that pati...
How are you utilizing vibratory devices for reducing pain associated with injection or procedures?
Specifically for intra-articular/bursal/tenosynovial/carpal tunnel injections: Our office purchased the vibration distraction devices over a decade ago based upon the promising use from the pediatric literature. Our providers were underwhelmed with their use in our adult patients and we all stopped ...
What chemotherapy, if any, would you offer for an elderly patient with congestive heart failure with completely excised Stage I classical Hodgkin lymphoma?
Radiation is a curative option here.
What chemotherapy, if any, would you offer for an elderly patient with congestive heart failure with completely excised Stage I classical Hodgkin lymphoma?
Radiation is a curative option here.
Would you include the entire hardware as part of ISRT for a patient with Stage IE DLBCL of the distal femur treated with upfront prophylactic nailing for impending fracture, who had a CR to chemotherapy?
Quite uncommon to encounter such a patient, but based on data for non hematologic tumors, no. Treat just the involved site with a generous margin, the latter never precisely defined, but depends on the tolerance of surrounding normal tissue. Parenthetically, it's often difficult to determine a CR to...
What dose and fractionation do you use to palliate mycosis fungoides lesions?
I will admit that I utilize a wide range of fractionation schedules, depending on the clinical circumstances when treating mycosis fungoides. The data suggests that 2 Gy x2 is not an effective palliative schedule, with a CR rate of only ~30% with almost all lesions requiring re-treatment (Neelis et ...
For patients with resected pancreatic cancer who received neoadjuvant gemcitabine + Abraxane, would you switch to gemcitabine + capecitabine to complete 6 months of peri-operative therapy?
I would only administer neoadjuvant gem + Abraxane in very rare circumstances. If, for example, I have already tried mFFX and it did not achieve the response needed to get a borderline tumor to resectability. In that case, it would be tempting to use G+A as adjuvant therapy, but I would still strong...
How do you manage MPN patients with acquired VWD in the perioperative setting?
The greatest risk of a very high platelet is bleeding not thrombosis, and it is fair to say that this appears to apply to myeloproliferative (MPN) thrombocytosis as opposed to reactive thrombocytosis (there is no correlation between the platelet count and thrombosis with either cause of thrombocytos...
How do you manage MPN patients with acquired VWD in the perioperative setting?
The greatest risk of a very high platelet is bleeding not thrombosis, and it is fair to say that this appears to apply to myeloproliferative (MPN) thrombocytosis as opposed to reactive thrombocytosis (there is no correlation between the platelet count and thrombosis with either cause of thrombocytos...