Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
What is your protocol for type of surveillance imaging (CT/MRI/PET) and frequency of follow-up after SBRT to a bone metastasis?
I typically have approached decisions regarding surveillance based on the site (i.e., spinal vs. non-spinal bone metastasis), indication for SBRT (i.e., definitive or post-operative, particularly in spinal metastasis patients who required initial debulking), and primary site (i.e., radiosensitive, s...
What neoadjuvant strategies do you utilize for initially unresectable biliary tract cancer?
Great question. While there is not prospective data, I tend to use the triplet chemo regimen of gem/cis/nab-paclitaxel based on the 20% conversion rate seen in this phase 2 study. There is an ongoing neoadjuvant study in IHCC that is investigating the triplet, but this is only open at select centers...
In a patient with esophageal cancer with lymph node involvement, would you consider treating with definitive chemo-radiation if they have a single area of retroperitoneal metastasis?
If a patient has non-regional retroperitoneal adenopathy without other distant metastasis (i.e., below the level of the celiac axis), that patient has M1 disease, and upfront definitive chemoRT would no longer be the standard of care (systemic therapy alone would be). However, I would then consider ...
If zolbetuximab was not given in first line in metastatic gastric cancer with CLDN 18.2, would you give it with second line ?
The short answer is no. Available data in later lines have shown essentially no single-agent activity (Klempner et al., PMID 37490286). Because zolbetuximab is a chimeric (mouse/human) IgG1 naked antibody that relies entirely on immune effector mechanisms (ADCC and CDC) to kill tumor cells, it does ...
What is your standard approach for patients with platinum and ICI refractory small cell lung cancer?
For many years, my standard approach has be either topotecan or paclitaxel. I actually prefer paclitaxel over topotecan for patients with rapid progression after first line therapy. In refractory patients, the RR with topotecan in trials is only about 10% (which seems about right from my practice), ...
Is there any evidence that ivermectin suppresses the PSA level in prostate cancer?
Is this even the right question, though? ADT drops PSA very reliably and yet does not cure patients. Finasteride suppresses PSA, but we do not use it as a mainstay of cancer treatment. Even if ivermectin *did* suppress PSA, unless there is a meaningful oncologic benefit (*at least* reduced recurrenc...
How does the POSEIDON meta-analysis results influence your decision on which patients should receive hormone therapy with post-operative radiotherapy for recurrent prostate cancer?
POSEIDON is another landmark analysis from the MARCAP consortium. It adds to the seminal work performed in localized prostate cancer (Kishan et al., PMID 35051385), which serves as the reference study for the use and duration of ADT with radiotherapy, but now in the post-prostatectomy setting.The st...
Would you consider adding gabapentin off label for use in the treatment of glioblastoma at this time?
As an author on the paper, let me emphasize the findings and speculate on the implications. Recently, a number of laboratories have unraveled stunning preclinical and mechanistic findings demonstrating the ability of a subset of malignant glioma cells to usurp neuronal circuitry to promote tumor gro...
How would the updated results of ECOG 3311 influence your adjuvant RT recommendations for HPV+ OPSCC?
This question refers to this manuscript (Burtness et al., PMID 40493877), which is a 4.5-year follow-up of ECOG E3311.The results broadly mirror those seen in previous reports. The most notable novel finding reported is that among patients with low-risk features (who did not get any adjuvant RT), th...
How would you manage the side effects/toxicities (e.g., pain, swelling, erythema) of adjuvant EBRT to the ear for cutaneous SCC?
I have had a few patients experience acute pain in the ear canal, probably from inflammation, wet desquamation, and bacterial overgrowth. Ciprodex Otic drops x 7-10 days have been helpful.