Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Should immunotherapy be standard of care for metastatic MSI-high colorectal cancer?
It should be a treatment option but not yet in the first line. My first option for MSI-H patients is to enroll in an immunotherapy trial. If not available, I'll usually reserve single-agent PD-1 inhibitors until after second line therapy. Recent data suggests that the Ipilimumab-nivolumab combo migh...
Do you omit anthracyclines in perioperative chemotherapy for gastric cancer?
The available data would suggest a very small benefit, if at all, for anthracyclines in the locally advanced setting.Although the MAGIC study established ECF as a standard-of-care, a contemporaneous French FFCD study revealed nearly identical outcomes with 5-FU/cisplatin alone.More recently, the res...
Which embolization approach is preferred for liver metastases from well differentiated neuroendocrine tumors?
Treatment options for metastatic GEP-NETs have evolved in recent years including PRRT which definitely affects our decisions for when and who will be eligible for liver-directed therapies (LDTs). In general, LDTs are appropriate for patients with G1/2 well diff. diffuse, unresectable liver metastas...
When do you give treatment breaks for patients with NSCLC undergoing chemoradiation with serious toxicity?
I agree with @Dr. First Last's approach. I am very aggressive in not introducing treatment breaks during radiotherapy. One approach that I occasionally use to "make up" for dose issues when a break is inevitable is to accelerate at the end of treatment to make up for the break rather than to specifi...
What is the best adjuvant treatment for resected NSCLC?
This is going to be a several part answer to a seemingly straightforward question. I’ll break this down into a few parts: 1) Which chemotherapy, 2) Targeted therapies in molecular subsets, 3) Anti-angiogenic agents, 4) The role of PORT (post-operative radiation therapy). 1. Which Chemotherapy: The s...
Which older patients with hormone receptor positive, HER2 negative breast cancer should receive chemotherapy?
Discussions with older patients are similar in many ways to the discussions with our younger patients. What is the risk of recurrence (taking into account anatamy and biology), what therapies might impact that risk of recurrence, what are the patient's comorbities, and what are the patients preferen...
When do you perform BRAF testing in colon cancer?
I now perform BRAF testing as close to diagnosis of metastatic cancer as possible. While it is not a predictive test, the prognostic value is important. We discuss prognosis with our pancreatic cancer patients differently than our CRC patients. Now, I think we should discuss prognosis differently wi...
When do you perform HER2 testing in patients with colorectal cancer?
HER2 amplification is seen in a small but distinct subset of colorectal cancer. This subset has 2 unique characteristics: They are predominantly RAS wild type tumors. They do not respond to anti-EGFR agents, i.e. HER2 amplification is a negative predictor of anti-EGFR antibody (cetuximab and panitu...
How do you perform geriatric assessment for cancer patients?
This is a HUGE topic. I would like to suggest the following 2 resources that you may find helpful. https://www.mycarg.org/?page_id=898 and the following one helps predict residual life expectancy independent of cancer diagnosis: https://eprognosis.ucsf.edu
Is there an age cutoff for when to avoid FOLFIRINOX in older patients with pancreatic cancer?
The original Conroy trial had a maximum age of 75 years old; but then the recent PRODIGE 24/CCTG PA.6 adjuvant trial increased the age limit up to 79. I think this reflects the idea that there are still good performing elderly patients who may well tolerate FOLFIRINOX, and I have treated patients in...