Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Does the possibility of future Lu-177–PSMA therapy change your current threshold to offer earlier metastasis-directed RT in oligometastatic prostate cancer?
There is a lot of excellent research being done on the efficacy and tolerance of combined Lu-177-PSMA therapy and EBRT. So far, the combination is well tolerated, and there is some data that sequencing the two to allow EBRT to treat the more “Pluvicto-resistant” lesions may help with efficacy.The qu...
What is your approach to systemic therapy in patients with ER+ HER2- breast cancer with invasion of the pectoralis muscle on imaging without overt chest wall involvement?
I would send the diagnostic biopsy for Oncotype DX testing - if it returns at 26 or higher, I would give neoadjuvant chemo and hope that the tumor shrinks back from the pectoralis. If it is 25 or less, we would consider neoadjuvant endocrine therapy. If this is ineffective would leave it up to her s...
How would you treat an elderly patient with stage I/II unfavorable classic Hodgkin Lymphoma, who could only tolerate 2 cycles of chemotherapy and has a Deauville 1-2 PET/CT re-staging scan?
Assuming a patient is responding favorably to therapy by PET/CT, there are 5 regimens that are supported by randomized trials and included in national guidelines: Chemotherapy-alone regimens ABVD x 2 + AVD x 4 (RATHL) BrECADD x 4 (HD21) Combined modality therapy regimens ABVD x 4 + RT (30 Gy) (H1...
How would you treat an elderly patient with stage I/II unfavorable classic Hodgkin Lymphoma, who could only tolerate 2 cycles of chemotherapy and has a Deauville 1-2 PET/CT re-staging scan?
Assuming a patient is responding favorably to therapy by PET/CT, there are 5 regimens that are supported by randomized trials and included in national guidelines: Chemotherapy-alone regimens ABVD x 2 + AVD x 4 (RATHL) BrECADD x 4 (HD21) Combined modality therapy regimens ABVD x 4 + RT (30 Gy) (H1...
When should surgical tumor resection be considered in patients with a low-grade glioma?
In adults with low-grade gliomas, there is substantial evidence suggesting that aggressive, early surgical resection improves outcomes and survival (Jakola et al., PMID 23099483). Historically, this has been particularly true for tumors that carry an IDH mutation or 1p/19q codeletion. This survival ...
In a patient with metastatic pancreatic cancer with diffuse liver metastases, would you consider whole-liver radiation to lower bilirubin so that they are daraxonrasib eligible?
I think it is an interesting idea. However, I would not expect the TB to decline after RT. Stable, maybe, but not a decline. If TB is rising, that is from parenchymal destruction, and radiation will not reverse it. If obstructive, only stenting would make sense.
Is there a rationale for treating medically inoperable stage I-III breast cancer patients with RT alone?
We treated stage III patients with "radical radiotherapy" with or without chemotherapy when I was a resident in the early 1980s, since they were considered SURGICALLY inoperable then. However, very high doses were needed (75-80 Gy to the primary using external beam followed by interstitial implants)...
Given the final publication of NSABP B-51, for which patients meeting trial eligibility would you still recommend regional nodal irradiation?
The very first thing that should occur before one makes a decision about what they are going to do is to understand how the trial was designed and who was actually accrued to it. The first point is that B51 was a superiority and not a non-inferiority trial. A very related point to that is that they ...
How do you interpret recent large retrospective analyses comparing radical prostatectomy vs. radiation for prostate cancer?
There have been numerous comparisons of RT vs. RP from a variety of study teams with various conclusions, and it often seems like the principal conclusion of the study is best predicted by the subspecialty from which the authors originated (urology vs. radiation oncology). As the question partially ...
How do you assess and counsel women with chronic post-lumpectomy or mastectomy pain?
Post-surgical breast pain is not uncommon. Estimates suggest that 25-60% of patients having breast surgery experience persistent pain, with symptoms lasting from months to years following breast cancer diagnosis and treatment (Langford et al., PMID 25439318; Gartner et al., PMID 19903919).Initial as...