Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How do you approach treatment of a glioblastoma in pregnancy?
Glioblastoma during pregnancy could be treated safely (to mother and fetus) with certain precautions and modifications. Collaboration and consultation with the patient’s obstetrician are essential. External shielding over the patient’s abdomen during treatment will decrease the external scatter radi...
In the setting of COVID-19, would you perform a SLNB for a patient incidentally found to have microinvasive ER+ ILC in contralateral prophylactic mastectomy following neoadjuvant chemotherapy for a locally advanced triple positive breast cancer?
I would not recommend SLN biopsy, independent of COVID-19. This patient's prognosis is overwhelmingly dependent on the locally advanced triple negative breast cancer, not the microinvasive ER positive breast cancer. Acknowledging that the ER positive cancer may have been larger than microinvasive be...
If an asymptomatic patient requires a delay up to a week before starting chemotherapy for Stage III lung cancer, do you also push back the radiation start date?
Typically, the reason for B12 and folate prior to chemotherapy is related to the drug that will be used, pemetrexed. Giving the premedication reduces hematologic and gastrointestinal toxicity to tolerable levels. One week typically will not make a difference and I would usually wait to start. Howeve...
How does data from the HIMALAYA trial impact your first line treatment selection for advanced HCC?
The results from the HIMALAYA trial with the combination tremelimumab (CTLA-4 inhibitor) and durvalumab (PD-L1 inhibitor) reported an OS of 16.4 months compared to 13.8 months for sorafenib which was statistically significant (HR 0.78, p-value of 0.0035). With the limited data presented at ASCO GI 2...
Which adjuvant chemotherapy regimen would you recommend for a peri-menopausal woman with synchronous stage IA primary breast tumors, one that is ER+HER2+ and the second ER+HER2-?
I would treat the patient with paclitaxel 80mg/m2 x 12 weeks plus trastuzumab for a year (Tolaney et al., Clin Oncol 2019). The more difficult question is the optimal anti-estrogen therapy: tamoxifen (TAM), TAM + ovarian suppression (OS), or aromatase inhibitor (AI) + OS. This is because the SOFT an...
What are best practices for radiation oncology patient and staff precautions with the COVID-19 pandemic?
COVID Update 1/30/21 Wow, it's been almost a year. Here are some updates from our practices at University of Maryland. We have successfully treated both PUIs and COVID+ patients at all of our practices. We have yet to have a patient to staff (or staff to patient) transmission. We do not break patien...
Are CHEK2 mutations a contraindication for breast conservation therapy with lumpectomy + RT?
Among women with early-stage breast cancer and moderate penetrance breast cancer susceptibility genes, such as CHEK2, decisions about breast surgery are largely based upon personal preferences. According to data from large population-based studies, women with CHEK2 pathogenic variants have about a 2...
Is there a role for peritoneal debulking in patients with peritoneal metastases from colorectal cancer?
This is a great question.Peritoneal metastasis (PM) is the 3rd most common site of colorectal cancer recurrence after liver and lung. PM is listed as M1c by the current AJCC staging. The best treatment approach is still uncertain. The current NCCN guidelines recommend "Complete cytoreductive surgery...
Should we be stopping new starts of patients who can be triaged for 2-3 months like prostate cancers on ADT when significant community spread of COVID-19 is detectable in our area?
I would for those patients requiring ADT, which is the way I interpreted the question. I want to elaborate more because @Dr. First Last brought up other scenarios we should consider and he brings some more good points: Many patients could get active surveillance for a period of time before ADT is co...
Would you recommend 3 or 6 months adjuvant chemo for low risk Stage III sigmoid cancer (T3/N1), but with positive LVI and PNI?
I would recommend 3 months of CAPOX in this case. For a patient with stage III colon cancer, the presence of LVI and PNI should not influence the treatment plan.