Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How do you manage anticoagulation/antiplatelet therapies with strong indications for uninterrupted therapy in the setting of urgent procedures?
If anticoagulation is absolutely contraindicated because of the bleeding risk of the procedure, then "bridging" will usually make the most sense, most of the time, with low molecular weight heparin such as enoxaparin. If dual antiplatelet agents are contraindicated, particularly in the first month a...
How do you manage anticoagulation/antiplatelet therapies with strong indications for uninterrupted therapy in the setting of urgent procedures?
If anticoagulation is absolutely contraindicated because of the bleeding risk of the procedure, then "bridging" will usually make the most sense, most of the time, with low molecular weight heparin such as enoxaparin. If dual antiplatelet agents are contraindicated, particularly in the first month a...
What is your experience with transesophageal lung mass biopsies?
Thoracic lesions requiring FNA in the mediastinum are often best approached with EUS–FNA, as the sedation and airway management are less complex than the EBUS, and the needle does not need to break through cartilage rings to access the lesion. On the other hand, a lung mass would require the needle ...
How do you advise a patient with a history of HR+ breast cancer who would like to go on HRT for postmenopausal symptoms?
I would say systemic hormone replacement therapy is generally not recommended because of concerns about recurrence. I would assess the severity of symptoms and explore non-hormonal options. If her main concern is vaginal symptoms, low-dose vaginal estrogen may be an option depending on the severity ...
In the high-risk adjuvant or metastatic setting when you initiate patients on ovarian suppression with the plan to start an AI, what protocol do you follow in terms of rechecking estradiol?
This is an area of intense interest, as well as uncertainty. In truth, unless the patient does not have a uterus, (unusual in premenopause) I typically follow clinical menses and have not followed estradiol.
What is the appropriate amount of time to allow for wound healing prior to post-operative radiation for metastatic disease?
I typically have waited about 4 weeks or so to start RT after ORIF. In addition to limiting risk of wound complications, this allows time for the patient to adequately recover from a pain perspective, since if one tries to treat earlier, the tolerance of treatment is often poorer. In situations wher...
How do you counsel patients/families whose goals of care are clearly aligned with a comfort-focused, end-of-life approach, but who are hesitant to formally enroll in hospice?
Hospice sounds like a 4-letter word to a lot of families! I find it important to distinguish the philosophy of comfort care vs. the benefit package associated with enrolling in hospice. Some people are able to be provided end-of-life comfort care without electing the hospice benefit, and that is fin...
Does TROP2 expression influence clinical decision-making for TNBC currently?
At this time, TROP2 IHC expression does not guide treatment selection for TROP2-directed ADCs in TNBC clinical practice. Exploratory biomarker analyses from ASCENT and TROPiCS-02 demonstrated that benefit from sacituzumab govitecan was observed across a range of TROP2 expression levels, without a cl...
What are your top takeaways in Thoracic Cancers from ASCO 2025?
More presentations that were interesting for the future, than immediately impactful in thoracic oncology this year at the ASCO meeting. Immediately impactful: 8006 and 8008 – Both in SCLC. 8006- IMforte trial suggesting improvement in survival with the addition of maintenance lurbinectedin to atezo...
How do you manage a Ta pure squamous cell carcinoma of the urinary bladder?
The ideal management of non-muscle invasive bladder cancer (NMIBC) with histologic variants remains controversial. The American Urological Association and the National Comprehensive Cancer Network guidelines recommend radical cystectomy for T1 patients with variant histology based on expert opinion ...