Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How do you approach a young patient with metastatic poorly differentiated thyroid cancer with rhabdoid/non-anaplastic features?
Unfortunately, this patient has a very poor prognosis. Due to the nature of her tumor being poorly differentiated, her disease is more likely than not to be refractory to radioiodine. If her disease in the thyroid and neck has not been addressed, external beam radiation therapy should be offered for...
What is your approach to evaluation in patients who present with erythromelalgia?
Erythromelalgia is a tough condition to treat. I usually break it down into diagnostic workup and treatment as follows: Diagnostic workup: I usually just get a CBC yearly to look for myeloproliferative disorders. Treatment: I have not had a lot of luck with topicals being too effective, so I usuall...
What is the role of GammaTile in the management of primary brain tumors and brain metastases?
GammaTiles are an intracranial brachytherapy product marketed by GT Medical Technologies consisting of a Cs-131 source imbedded within a collagen matrix. Proponents of the technology argue that advantages of GammaTiles over external beam radiotherapy techniques include the ability to “start” the rad...
Would you offer adjuvant pembrolizumab to a stage II-III adenocarcinoma of the lung who had a complete pathologic response to 4 cycles of cisplatin/pemetrexed/pembro (KN-671)?
The question posed is a central question of investigation and debate today.In my view, the patients most likely to derive benefit from adjuvant immunotherapy after receiving neo-adjuvant chemo-immunotherapy are those with the best responses to neo-adjuvant therapy. The patients I would least likely ...
Do you consider ablative radiation therapy for oligometastatic colon cancer with 5 pulmonary lesions responding to chemotherapy?
The definition of oligometastatic colorectal cancer (OCRC) varies quite significantly. The European Society for Medical Oncology (ESMO) defines OCRC as having up to five lesions in no more than three metastatic sites but can sometimes have more if complete eradication is possible. There is no random...
Would you consider adjuvant TDM-1 for a patient with HR+,HER2+ breast cancer with pCR in the breast but N1mic disease post neoaduvant chemotherapy?
The Katherine Trial (NEJM 2019:380;617-280) was a randomized trial of trastuzumab emtansine (TDM-1) versus trastuzumab for patients with residual disease after HER2-directed neoadjuvant treatment. The trial was positive for TDM-1. The randomized patients included those with residual invasive disease...
For pre-menopausal patients with high-risk ER+ disease, and who desire pregnancy, what is the best time frame to pause endocrine therapy to allow for pregnancy?
Evidence suggests that pregnancy after a breast cancer diagnosis, even among women with hormone positive tumors, does not increase the risk of recurrence, however this has not been prospectively studied. Current guidelines suggest waiting 2 years, however this is based on retrospective data, that is...
Do you offer memantine for patients undergoing PCI?
Extrapalating on 0614, I do use memantine for patients undergoing PCI. I do this for 6 months. These are patients that are expected to live even longer than brain met patients. And given the low toxicity, I think it would be rude not too (as one of my former students would say!)
When would you recommend adjuvant radiation therapy for a patient with a completely resected (negative margins) dermatofibrosarcoma protuberans?
Agree, we usually do not. Especially if these patients are completely cleared with Mohs surgery, which is found to have lower recurrence rates than WLE.
How do you manage hemophilia A carriers with no history of bleeding complications but with mildly low factor VIII activity (6-40%)?
This is a wide range, if no history of bleeding then do not need factor on a regular basis. But for invasive procedures/surgery/trauma depending on what their levels are at baseline and the bleeding risk of the procedure, you will need to use factor 8, antifibrinolytic agents, or DDAVP. Same about t...