Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
When should you use single-fraction radiotherapy for spinal cord compression?
The SCORAD III trial is practice changing. But I do NOT plan to treat ALL patients with spinal cord compression with a single fraction of 8 Gy now. Here is why: SCORAD III is extremely important new study for the management of metastatic epidural spinal cord compression (MESCC) for patients with sho...
After WBRT, what systemic therapy would you favor for maximal CNS penetrance in a patient with triple negative metastatic breast cancer and multifocal CNS disease?
With patients such as this, I would usually recommend the following: 1. Genomic testing (Strata, Foundation 1, etc.) to look for a mutation that might be targetable with a TKI that crosses the blood brain barrier well 2. Re-testing of the CNS cytology for HER2, given that we do have multiple drugs w...
What is your strategy for ovarian suppression if unable to achieve goal estradiol levels with leuprolide 3.75mg monthly dose?
Monthly therapy rarely fails to induce adequate suppression. The choice of options will depend on whether the patient planned permanent or only temporary suppression AND the risk of recurrence of the cancer. If she will accept permanent suppression and has high risk disease, oopherectomy would be th...
Do you routinely check tumor genomics, including POLE status for new endometrial cancers?
Update provided March 23, 2026This is a great question for two main reasons: Resource utilization What am I going to do with the data I would choose to send POLE testing on patients where you think the data might impact your care... the challenge with that is that we lack strong prospective data to ...
Besides GI evaluation and testing for celiac, what other testing do you consider with a patient with unexplained Iron deficiency anemia and a negative bleeding history?
I assume this question comes after endoscopies are negative. Autoimmune gastritis is 30 times more frequent than celiac disease. So anti-parietal cell antibody should be ordered. >30 likely, >50 usually diagnostic. If still negative, a history of long-duration therapy for reflux will explain iron de...
Would you expect to see severe arthralgias within the first few days of immune-therapy in a patient without history of autoimmune disease?
The short answer is: Absolutely!The long answer is:From a mechanistic standpoint, it is common to see severe arthralgias within days of initiating immune checkpoint inhibition, even in a patient without a prior autoimmune diagnosis.Checkpoint inhibitors rapidly release inhibitory signals on T-cell a...
How would you approach missed doses of fulvestrant due to COVID-19?
There is no specific guideline for this. But, as we do for patients who occasionally miss fulvestrant doses, I would try to schedule the next dose as soon as possible. Another option would be to consider an alternative endocrine therapy option such as AI, tamoxifen, which do not require for patients...
Would you give a PARP inhibitor, and at what dose, to a patient with end-stage renal disease on hemodialysis after completion of 6 cycles of carboplatin and paclitaxel for advanced ovarian cancer?
This is an interesting question, for which I don't have a quick answer.When it comes to PARP inhibitors (PARPi), there is compelling data for its use as maintenance therapy as well as recurrent treatment. The article by Kurnit et al., is a nice summary of the data available supporting PARPi use (Kur...
How do you approach treatment of a glioblastoma in pregnancy?
Glioblastoma during pregnancy could be treated safely (to mother and fetus) with certain precautions and modifications. Collaboration and consultation with the patient’s obstetrician are essential. External shielding over the patient’s abdomen during treatment will decrease the external scatter radi...
In the setting of COVID-19, would you perform a SLNB for a patient incidentally found to have microinvasive ER+ ILC in contralateral prophylactic mastectomy following neoadjuvant chemotherapy for a locally advanced triple positive breast cancer?
I would not recommend SLN biopsy, independent of COVID-19. This patient's prognosis is overwhelmingly dependent on the locally advanced triple negative breast cancer, not the microinvasive ER positive breast cancer. Acknowledging that the ER positive cancer may have been larger than microinvasive be...