Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
What is your preferred approach to adjuvant therapy for a Masaoka Stage III thymic carcinoma after R1 resection?
The data for adjuvant treatment of thymic carcinoma is relatively scarce, with most studies and series on this topic have traditionally included all thymic malignancies including thymomas. In the scenario presented in the question, there are multiple risk factors- thymic carcinoma, R1 resection both...
How do you modify HMA treatments for a patient with high-risk MDS experiencing prolonged cytopenias after each cycle?
When using azacitidine for the treatment of MDS, I adjust the dose in case of cytopenia for cycle 2 onwards. If there was no baseline cytopenia (ANC >1.5, PLT >75K) but cytopenia developed with treatment, the subsequent cycle is delayed until counts recover, and the dose is based on the nadir and t...
How do you modify HMA treatments for a patient with high-risk MDS experiencing prolonged cytopenias after each cycle?
When using azacitidine for the treatment of MDS, I adjust the dose in case of cytopenia for cycle 2 onwards. If there was no baseline cytopenia (ANC >1.5, PLT >75K) but cytopenia developed with treatment, the subsequent cycle is delayed until counts recover, and the dose is based on the nadir and t...
In patients with nasopharyngeal SCC that have an excellent response to induction chemo, do you alter your chemo-RT dose/volumes in any way?
I agree with Dr. @Dr. First Last. I do not change my volumes based on response to induction chemotherapy. It may be difficult to outline the nodal volume if there is complete response to chemo but I have not really encountered that scenario so far. I use the initial PET and diagnostic CT scans fused...
How would you manage an isolated nodal recurrence of breast cancer in a patient with a prior history of mantle-field radiation?
Nodal recurrences, especially in unresectable regions, are especially challenging cases in the context of reRT. At a high level, the first thing to think about is resectability. If resectable, the usual approach is surgery, then adjuvant RT to unirradiated areas, and adjuvant chemotherapy. If unrese...
What is your approach for testing speech in bilingual patients undergoing an awake craniotomy for glioma resection?
In a bilingual patient, it is important to assess the patient's language function in both languages. This would include pre-operative non-invasive functional mapping as well as intra-operative awake mapping. Areas of language function and connectivity are less discrete than sensory and motor functio...
What is your approach to prescribing gabapentin for oral mucositis prophylaxis during chemoradiation?
It can be a useful adjunct therapy, especially for patients getting radiation for oral cavity cancer. Randomized trials have been conflicting but some have shown benefit in a prophylactic setting. In my experience, patients tend to need less narcotic medication (usually able to get by with gabapenti...
How do you treat a patient with widely metastatic, non T790M mutated, EGFR exon 20 insertion mutated lung cancer?
The EGFR exon 20 insertion mutations represent approximately 9% of all EGFR mutations, and affect a similar demographic/clinical group - never/light smokers, adenocarcinoma, tending towards a younger age (Oxnard et al., PMID 23328547). Unfortunately, the data (preclinical and clinical) to date do no...
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...
Are maintenance therapies for ovarian cancer being held at your institution due to COVID-19?
Patient safety and health care worker safety are of the upmost importance for us. We are doing telehealth visits and able to deliver oral drugs to patient's homes. For infusion visits, those are being decided on a case by case basis, depending on the patient and their disease status.