Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How do you manage thrombocytopenia when radiating the spleen?
Radiation oncologists are occasionally asked to see patients with symptomatic splenomegaly (early satiety, dyspnea, and pain) and evaluate for radiation therapy. Many such patients have non-functional bone marrow from diseases such as primary myelofibrosis. This leads to extramedullary hemoatopoiesi...
What criteria do you use to select which patients with thoracic mesothelioma to send for an extrapleural pneumonectomy or pleurectomy/decortication?
We approach each patient's case individually when considering multi-modality treatment of pleural mesothelioma; multi-disciplinary communication and planning is vital prior to the initiation of any therapy. Patients with stage IIIA disease or less with epithelioid or biphasic (with predominant epit...
How do you interpret PSMA/PET with focal prostate activity after XRT currently on ADT with stable PSA?
The most concerning element of the case presented is that the patient’s PSA continues to be ≈ 5 while on ADT with presumably castrate levels of testosterone, which should be verified. The current PSA is one order of magnitude greater than would be expected from the effect of ADT alone possibly indic...
How would you approach a patient with M0 castrate-resistant prostate cancer started on enzalutamide who continues to have increasing PSA levels without metastases seen on imaging?
This is an important question, given the new FDA approvals and NCCN guidelines in the M0 CRPC treatment space and likely increased use of apalutamide and enzalutamide in these men with PSA-only CRPC. In general, these studies continued treatment until metastatic progression (soft tissue or bone) was...
What treatment regimen would you recommend for young adults with platinum refractory relapsed germ cell tumors?
We assess the patient risk by IPFSG score, and if it is high score or has extragonadal primary site then we consider tandem high dose chemotherapy and autologous transplantation https://onlinelibrary.wiley.com/doi/full/10.1002/acg2.47 The data sometimes is unclear on the role of HDCT . - the larges...
What adjuvant therapy, if any, is best for mucinous tubular and spindle cell carcinoma of the kidney?
Mucinous tubular and spindle cell carcinoma (MTSCCC) of kidneys is a rare RCC variant which was first described in WHO 2024 updates of the classification of RCC (Moch et al., PMID 35853783). Most cases are diagnosed incidentally and typically have an indolent course with good long-term prognosis (Ku...
What neoadjuvant regimen would you give a patient with multicentric IDC consisting of TNBC and concurrent ER/PR- HER2+ breast cancer with ER/PR- HER2+ axillary LN mets?
In cases where we had heterogenous multicentric TNBC and HER2+ disease and the patient had no major cardiac risk factors, we tended to use more AC-THP vs. TCHP in those cases. The addition of the anthracycline to the taxane was felt to be appropriate to better cover both types of cancers (although c...
Would you offer consolidative full dose chemo-RT for local residual pancreatic disease in a patient with stage IV pancreatic adenocarcinoma with excellent response after induction chemotherapy?
I think radiotherapy can selectively be considered in patients like this. The potential roles of radiation therapy could include: Palliation of local symptoms. RT is very effective at palliating symptoms such as pain related to celiac plexus infiltration, etc. Lawrence et al., Journal of Clinical O...
What are your top takeaways in Head & Neck Cancers from ASCO 2024?
The PATHWay study Abstract 6008: checkpoint inhibitor therapy has become instrumental in the treatment of recurrent and metastatic head and neck squamous cell carcinomas. However, we still do not have data to inform us whether treatment with such agents is beneficial in the adjuvant setting. In thi...
When giving concurrent chemoradiation therapy, is it important that the infusion be prior to RT as opposed to after RT?
Radiobiological data suggest better cell kill when cisplatin is given before RT and then given after (1.7x vs. 1.2x) and similarly when delivered daily vs when delivered weekly. In practice, for that reason, we do it before RT and early in the week (Monday or Tuesday). The ongoing cervix OUTBACK tri...