Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
What is your approach to screening for malignancy in dermatomyositis patients who do not have a high risk antibody profile and whose disease responds well to treatment?
This is a great question and one that is very relevant to our clinical practice. Different myositis specific and associated antibodies seem to carry different risks in their associations with cancer. My colleague, Dr. Alexander Oldroyd, has written our current guidelines on cancer screening for pati...
For a patient with large volume glioblastoma, what do you do if they are found to have a subdural infection in the middle of chemoRT requiring repeat surgery?
In this scenario, the patient will likely stop the daily treatments for a variable period of time that I would estimate to be measured in weeks while recuperating from surgery and receiving IV antibiotics. When cleared for radiation, I would start by doing a new Simulation using an updated MRI to ac...
What role do you see for functional imaging in selecting patients with HPV-associated oropharyngeal cancer for radiation dose de-escalation?
This study, led by Dr. @Dr. First Last, is unique in using F-MISO PET to select patients for a notably aggressive de-escalation plan, to a 30 Gy total dose for responding patients. We need to wait for long-term results before accepting it in the clinic, notwithstanding that F-MISO is not widely avai...
Would you continue or stop anticoagulation for a DVT/PE in a patient with active cancer who has completed 6 months of therapy?
This is an important question that we didn’t really have a clear answer for… until this year when an NEJM RCT was published! Mahé et al., PMID 40162636 In this RCT, patients with cancer-associated VTE who completed 6 months of full-dose apixaban were randomized to half-dose apixaban vs. full-dos...
For patients with HCC that have stable disease on immunotherapy alone, would you consider adding bevacizumab at the time of disease progression and continue immunotherapy?
Yes, this is applicable to patients who are on single agent immunotherapy, since the atezo/bev combination carries different mechanism of synergistic potential than single agent immunotherapy. Notably, currently approved second line agents are indicated after progression on sorafenib, however, curre...
Are you using tarlatamab for neuroendocrine carcinomas (NECs) and poorly differentiated neuroendocrine tumors of GI (non-lung) origins?
We have treated a few patients with DLL3+ extrapulmonary NECs (epNECs) with tarlatamab, but we have not reported our experience yet. There have been responses, but mostly short-lived, but I know of cases where the responses were more durable than one would expect in epNECs progressing on first-line ...
How should elevated PT of unclear etiology and significance be evaluated?
Mild prolongation of the prothrombin time (PT) may represent a normal ‘outlier’. If there is no obvious explanation for a moderate to marked prolongation of the PT (for example, anticoagulation therapy effect, liver disease, nutritional deficiency like vitamin K deficiency. then the next step is to ...
In patients with essential thrombocythemia (ET) receiving hydroxyurea for cytoreduction who develop anemia — whether hydroxyurea-induced or from a concurrent etiology such as CKD — would you use ESAs?
This is an important question. Patients with ET should not have anemia related to the ET itself. Thus, assessing the etiology of the anemia is very important. If the anemia is from hydroxyurea, the first step is to lower the dose of the hydroxyurea. Controlling platelets should not come at the expen...
In patients with essential thrombocythemia (ET) receiving hydroxyurea for cytoreduction who develop anemia — whether hydroxyurea-induced or from a concurrent etiology such as CKD — would you use ESAs?
This is an important question. Patients with ET should not have anemia related to the ET itself. Thus, assessing the etiology of the anemia is very important. If the anemia is from hydroxyurea, the first step is to lower the dose of the hydroxyurea. Controlling platelets should not come at the expen...
In light of Aizer et al. data presented at ASCO 2025, what is your threshold for offering SRS/SRT in patients with multiple brain metastases?
Over the past 4 decades, the treatment of brain metastases has been evolving along with advances in technology, from simple whole brain radiation (WBRT) with opposed lateral fields to IMRT-driven treatment (HA-WBRT); similarly, in the field of SRS/SRT, we have pushed the envelope of what we can achi...