Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
What is the timing of onset of alectinib induced ILD, and is there any correlation between dose and the occurrence of ILD?
There is wide variability in the timing of onset of ALK TKI-induced ILD. In a single-institution retrospective analysis published by Koshikawa et al., PMID 32237210, onset specifically of alectinib-induced ILD ranged from day 9 to 531. Risk of ALK TKI-induced ILD was associated with older age and wo...
Would you give adjuvant chemotherapy to a distal esophageal adenocarcinoma T3NxM0 who s/p chemo-radiation and esophagectomy, had a complete pathologic response (ypT0N0)?
For patients with esophageal adenocarcinoma who receive neoadjuvant chemoradiation, there are no data to support the use of adjuvant chemotherapy, irrespective of the pathologic response. However, if the patient does not have a pathologic complete response, adjuvant nivolumab is indicated according ...
How would you treat an essential-like tremor secondary to tumor (e.g. glioma)?
This is a great question. The first step in managing tremor in the setting of a tumor or underlying mass is to first determine the phenomenology. It is not uncommon for dyskinesias like chorea or dystonia to arise after onset of tumor or treatment of tumor. Thus, looking for subtle (or not so subtle...
In which situations do you consider post-mastectomy radiation therapy when the patient has a localized node-positive breast cancer with a complete nodal response and minimal residual disease in the breast post-neoadjuvant chemotherapy?
This is an area of open study as we await the results of NSABP B-51. Off study at this time, I discuss the role of PMRT with all patients, with cN1 patients with a pCR in the nodes. I discuss PMRT is likely to provide a locoregional recurrence benefit, though survival advantage is unclear. Factors t...
Would you change AR signaling inhibitor in a patient with high volume metastatic castration-sensitive prostate cancer who started darolutamide with initial plan for docetaxel but in whom chemotherapy was eventually deferred?
The ARASENS trial showed a survival benefit for the combination of ADT with chemotherapy and Darolutamide in mHSPC. In a patient with high-volume disease who has been initiated on Darolutamide but in whom chemotherapy was planned but then deferred, I would continue with Darolutamide if the patient i...
Would you offer a patient with MMR-deficient colon cancer who underwent surgical resection of metachronous liver metastases "adjuvant therapy"?
In the general population of colorectal cancer patients with upfront resectable liver metastatic disease with low clinical risk, resection followed by a risk–benefit discussion regarding adjuvant chemotherapy or surveillance is appropriate. Fluorouracil-based chemotherapy compared to observation has...
Do the level of positive lupus anticoagulant titers correlate with the risk of VTE?
The lupus anticoagulant test is either positive or negative. It’s not reported out at a titer. The test needs a two-step confirmation, the first being the addition of mixed plasma to rule out a factor deficiency and the second confirmation being the addition of phospholipids and showing normalizatio...
Do you recommend routinely getting periodic 24-hour urine monoclonal protein study for patients with active multiple myeloma?
In short, no. I like to perform at the time of diagnosis and then at key points in the patient's journey if it was grossly abnormal (at the time of a bone marrow biopsy, for example). Patients definitely do not enjoy it. It does allow for IMWG response assessment, which is mandated for patients on t...
How do you approach a patient with discordant breast cancer risk prediction scores for prevention?
It's not uncommon to come across discordant lifetime breast cancer risk estimates between routinely used risk assessment models such as Gail, TC V8.0, Claus, and CanRisk. These models differ widely in the risk elements, ability to incorporate results from germline panel testing/PRS, and their streng...
Do you consider downstaging neoadjuvant cemiplimab for borderline resectable CSCC in order to facilitate surgical resection?
Very good question. Data from use of neoadjuvant therapy in many solid tumors has shown that when they clinically regress, actual pathologic response is more heterogeneous. Although an area can appear to have a complete clinical response- random biopsies can show areas of viable microscopic tumor st...