Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How would you manage a CVST secondary to a traumatic brain injury with the presence of intracranial hemorrhage?
When dealing with CVST after TBI, the mechanism of injury is not the same as a spontaneous CVST. There is often direct injury to the vein or the area overlying it. Given that these patients often have other traumatic injuries, and given the lack of clear evidence to support one therapy or another, I...
When, if ever, will you utilize T-DM1 in metastatic HER2+ breast cancer given trastuzumab deruxtecan's significantly improved efficacy vs T-DM1?
We now have very compelling data that trastuzumab deruxtecan (T-DXd) is highly effective in the second line setting and superior to T-DM1. The announcement of results came with the statement that "this study will lead to a paradigm shift in the treatment of Her2-positive metastatic breast cancer". S...
In elderly patients with advanced melanoma and idiopathic pulmonary fibrosis receiving active antifibrotic therapy, would neoadjuvant or adjuvant immune checkpoint inhibition be preferred?
I'd be very careful with the use of immunotherapy in an elderly patient with any sort of autoimmune disease, especially when receiving disease-modifying therapy. Having said that, there is no such contraindication to giving immunotherapy in such patients. Neoadjuvant setting: It is always preferred ...
How do you reconcile the differing results of the C-POST and KEYNOTE-630 trials when discussing treatment options with high-risk CSCC patients?
I explain that the two trials enrolled different risk populations, which likely accounts for the apparent discrepancy in outcomes — but when you look closely, they actually lead to the same clinical conclusion. C-POST deliberately enriched for very-high-risk patients (using well-established adverse ...
What are your top takeaways in GI Cancers from ESMO 2025?
1. MATTERHORN StudyThe global phase III MATTERHORN trial enrolled 474 patients with resectable gastric or gastroesophageal junction adenocarcinoma, randomized to receive FLOT alone or FLOT plus durvalumab. The primary endpoint, event-free survival (EFS), was previously reported as positive. Adding d...
How would you treat a patient with Gleason 8 or 9 prostate cancer, pretreatment PSA 15-24, with retroperitoneal adenopathy?
I would offer a similar approach to that described nicely by @Dr. First Last and @Dr. First Last: definitive RT+ADT+abiraterone, with SIB to the grossly positive nodes. My caveats and additions are: I start with a frank discussion with the patient re: evidence for various scenarios and general prog...
Would patients receiving targeted therapies be eligible for TTFields for brain metastases?
It is unknown whether NSCLC brain patients receiving targeted therapies should also receive TTFields. The most common patients would be those harboring EGFR mutations or ALK rearrangement. This would need to be studied and should not be presumed to be safe, as other unforeseen toxicities have occurr...
How would you advise a younger patient with residual/recurrent optic nerve meningioma, proceeding with radiotherapy, about the risks of malignant transformation or induction of other brain malignancies because of radiation?
The risk of malignant transformation of an optic nerve sheath meningioma (ONSM) after RT appears to be remarkably low, much lower than the risk of blindness from an untreated, progressive ONSM. In a younger patient, I would lean toward RT for patients with imaging progression or early visual loss, ...
What would be your radiotherapy plan for a patient with recurrent GBM (WHO grade 4, IDH wild-type) s/p 2 prior resections with no prior radiation?
The scenario described in this clinical case is not uncommon. I have had patients who either live several hours away from our center or were unwilling to receive the Stupp protocol of 60 Gy in 6 weeks and were successfully treated with 3 weeks of hypofractionated RT (HFRT). HFRT over 1–3 weeks (25 G...
How would you manage a rare presentation of an older adult after gross total resection of an "infant-type hemispheric glioma" of the left frontal lobe, IDH1 negative and negative for MYB fusions?
Infant-type hemispheric gliomas (IHGs) are rare high-grade astrocytic tumors characterized by giant size and abundant vascularity, often with regions of cystic transformation. They are aggressive brain tumors that occur during early infancy, usually between 0 and 12 months of age. They are often ver...