Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
For patients with metastatic thymic carcinoma, is there a role for local treatment options such as SBRT for oligoprogressive or oligopersistent disease after systemic therapy?
Of course, there is no data on this question for people with thymic carcinoma. Metastatic thymic carcinoma is generally treated with systemic therapy which is guided to some extent by the histologic subtype of the tumor. Most commonly, we would utilize a regimen such as CAP (cyclophosphamide, doxoru...
What is the consensus on giving Pemivibart for Pre-Exposure COVID prophylaxis in immunocompromised patients?
The SARS-COV2 virus that caused COVID-19 infection in the early pandemic caused significant morbidity and mortality to immunocompromised patients including those with blood cancers. Therapies such as remdesivir, paxlovid, antibody neutralizing therapeutics Evusheld antibody for prophylaxis, and the ...
What is the consensus on giving Pemivibart for Pre-Exposure COVID prophylaxis in immunocompromised patients?
The SARS-COV2 virus that caused COVID-19 infection in the early pandemic caused significant morbidity and mortality to immunocompromised patients including those with blood cancers. Therapies such as remdesivir, paxlovid, antibody neutralizing therapeutics Evusheld antibody for prophylaxis, and the ...
For what duration should abiraterone be used in a patient with biochemical and pelvic node recurrence (N1M0) who had prior definitive therapy with either RP or RT?
This is a similar but slightly different question than the one answered by Attard et al., PMID 34953525. This meta-analysis of randomized trials demonstrated a survival benefit with the addition of 2 years of Abiraterone + ADT compared to ADT in men who received definitive management for N1 prostate...
Would you consider adding abiraterone, in addition to ADT, for patients with less than very-high risk localized prostate cancer but high clinical-genomic metastasis risk after EBRT?
This is a very tricky area to be sure. The short answer is yes, I do in carefully selected patients.It is well established that genomics correlates with biology in the mHSPC and mCRPC settings. Now, there is emerging data that genomics correlates well with biology in the localized disease setting (e...
Would you use abiraterone or docetaxel in addition to ADT and radiotherapy for patients with very high risk, node-negative prostate cancer?
The most recent update from STAMPEDE's abiraterone arm in the M0 N0 very high risk setting was reported here: Attard et al., PMID 34953525 and strongly suggests that abi/ADT for 2 years plus radiation improves MFS and OS significantly and should be standard of care for men who are choosing RT in thi...
For patients with triple negative breast cancer who are planned to receive adjuvant pembrolizumab, would you recommend pembrolizumab be held until radiation is complete?
This will become a practical issue for radiation oncologists as four drugs are now approved for adjuvant treatment after neoadjuvant chemotherapy including pembro, xeloda, T-DM1, and olaparib. Out of these, olaparib and xeloda were done sequential after radiation as concern about increased side effe...
Do you use immune checkpoint inhibitors in NSCLC patients with pre-existing, well-controlled autoimmune disease?
While there is limited data on the use of PD1 inhibitors in patients with pre-existing autoimmune conditions; in patients with metastatic NSCLC with limited options, it warrants consideration. This is obviously a high risk population to treat and close monitoring and co-ordinated care with specialis...
Does your treatment approach for NK/T cell lymphoma of the nasal cavity differ depending on the volume and extent of disease?
There has been a recent (2021), updated review of treatment guidelines published by ILROG which provides very detailed recommendations including some considerations about systemic therapy. Qi et al., PMID 33581262.They offer treatment field suggestions based on the anatomic location of the tumor, di...