Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
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.
Does receiving IVIG confound the result of SPEP and/or UPEP?
IVIG being a product of polyclonal immunoglobulins may ‘produce’ a monoclonal spike if the AUC is falsely calculated by the reader. IFE usually shows polyclonal banding but every now and then a monoclonal band is picked up. Being an IgG molecule with a 21 day halflife; and with the assumption that i...
Is there a correlation with severity of rash as an adverse event and response rate with capivasertib?
While it is tempting to hope that patients with significant side effects on targeted therapies might be more likely to demonstrate an antitumor response to that treatment, and there is limited data to suggest a possible correlation between immune-related adverse events and response to immunotherapy,...
What clinical factors influence your first line treatment selection in advanced HCC?
With now many options of therapy for the treatment of advanced HCC, this is good news. It is also a challenge of how to pick and choose, and what factors may influence the choice of first line treatment.The possible choices would be either the combination of checkpoint inhibitor plus an add-on thera...
How does neoadjuvant chemo-immunotherapy impact your decision on hypofractionation/dose fractionation for locally advanced NSCLC, now getting RT alone?
If a patient has already received 3-4 months of a platinum-doublet chemotherapy during the chemo-immunotherapy phase, then it's always my preference to omit further chemotherapy and recommend RT alone. The rationale for this recommendation is that we don't administer additional chemotherapy to patie...
Do you approach the treatment of post-lumpectomy DCIS which is only present within an intraductal papilloma differently, if it does not involve adjacent breast tissue?
From the medical oncology perspective, I would consider chemoprevention with endocrine therapy for this patient. Prior series have shown elevated relative risk in patients with papillomas with atypical cells (although not as high as DCIS itself). I am not sure about the size of the DCIS within the p...