Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Do you offer memantine for cognitive preservation to glioma patients?
I do not as there is currently no evidence to support this. There was a trial conducted by the RTOG for whole brain RT patients with mets which demonstrated a trend towards improvement in time to cognitive decline (53.8 % at 24 weeks for memantine vs 64.9 % for placebo), executive function at 8 and ...
Is dyspnea without radiation pneumonitis a side effect of lung radiation?
Thanks for the interesting question. I would want to know: on what basis are we saying that the patient does not have radiation pneumonitis (RP)? I am going to assume that this is being stated since the imaging findings are underwhelming in this case. Assuming that this is the case, I would answer: ...
Would you give immunotherapy to patient with metastatic NSCLC who had liver transplant for hepatocellular carcinoma and now is progressing on chemotherapy?
This highly challenging question addresses a very important general issue in the context of a unique patient case. How far can we push the boundaries of using checkpoint inhibitors in understudied patient populations at significantly increased risk from adverse events? Or in different words, how muc...
What type of surveillance plan should one use to follow a young person after orchiectomy for a >3cm pure mature teratoma of the testicle?
I presume hCG and AFP were normal as well as appropriate imaging studies, thus a clinical stage I pure teratoma. These patients have a 25% probability for relapse and should be on regular surveillance. We have published on this topic previously. We prefer studies ( serum hCG, AFP, abdominal CT scan ...
What is your approach to patients with muscle-invasive bladder cancer who are ineligible for neoadjuvant cisplatin-based chemotherapy?
The data supporting the use of neoadjuvant chemotherapy for bladder cancer is derived from 2 randomized trials and a meta-analysis. The randomized trials demonstrating benefit used MVAC and CMV, respectively, both cisplatin-based combinations. The meta-analysis results support the use of neoadjuvant...
Should patients with muscle invasive node negative bladder cancer wishing to have bladder preservation receive chemoRT alone or neoadjuvant chemotherapy followed by chemoRT?
The best evidence that we have does not support neoadjuvant chemotherapy before chemo-RT for bladder cancer. One RTOG trial, admittedly underpowered, and the MRC meta-analysis suggest that, while that benefit may exist for cystectomy, it either doesn't exist or is simply too small to detect for chem...
What role, if any, do biomarkers play in selecting appropriate patients for neoadjuvant cemiplimab in cutaneous squamous cell carcinoma?
Cutaneous squamous cell carcinoma (CSCC) is primarily a UV radiation driven malignancy and harbors many mutations. These cancers generally respond very favorably to PD-1 pathway inhibition, and thus biomarkers do not currently play a role in patient selection for neoadjuvant cemiplimab in CSCC. In t...
How would you treat locoregionally recurrent anal CA?
Surgical resection is standard of care for isolated locoregionally recurrent anal cancer - if the disease is resectable. Resectable disease includes local recurrence in the anal canal and limited nodal disease (i.e. mesorectal, possibly inguinal). Fixed pelvic side wall recurrence (nodal or direct e...
How do you approach evaluation and management of arthralgia in a patient after CAR-T cell therapy?
This is a great question - part of cytokine release at syndrome includes joint pain. So my questions are: How far after? What was the reason for the CAR-T? These are vital questions to understand first. To that be said - the answers will determine if you give a one-and-done treatment or long-term....
How do you approach evaluation and management of arthralgia in a patient after CAR-T cell therapy?
This is a great question - part of cytokine release at syndrome includes joint pain. So my questions are: How far after? What was the reason for the CAR-T? These are vital questions to understand first. To that be said - the answers will determine if you give a one-and-done treatment or long-term....