Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Is there an age cutoff for when to avoid Gem/Nab-Paclitaxel in older patients with pancreatic cancer?
I have a lot of experience using this regimen in elderly patients due to the setting where i practice. In the MPACT trial the oldest patient enrolled was 88 and 10% of patients were aged over 75. I have treated many patients over the age of 85 and even into early 90s if ECOG reasonable. I usually rx...
When is lanreotide preferred over octreotide in GI neuroendocrine tumors?
As far as I am concerned, the drugs are equally effective, assuming the drugs get delivered correctly. The advantages of lanreotide are, as others have mentioned, a more reliable delivery method being given SC instead of IM. Also, lanreotide has faster absorption and it takes a shorter time to achie...
Should enzalutamide be given concurrently with Sip-T in castration-resistant metastatic prostate cancer?
Enzalutamide was still in early development when Sip-T was approved. Currently there isn’t enough data in the randomized setting, to justify the use. It’s a fascinating clinical question, and hopefully during the next couple of years, more data will become available.
How do you taper steroids for patients with symptomatic edema following standard chemoradiation for GBM?
I agree with above and would add that decreased production of corticosteroids by the adrenals does not typically occur until after a patient has been on steroids for at least 3 weeks. If you have a patient on steroids for less than this time period I suggest a rapid taper that is based on symptom co...
When should adjuvant chemotherapy be offered to patients with soft tissue sarcoma of the extremity?
The disclaimer is, this continues to be an area of debate and discussion. Having said that, the best I can do in this forum/format: Good PS, normal organ function, high-risk STS (stage 3), extremity/superficial trunk location, excluding low/non-responsive histologies (e.g. CSS, ASPS, SFT...) should ...
Do you test your esophageal and gastric specimens for HER2 using IHC, FISH, or both?
We ask for IHC and reflex FISH for IHC score of 2. I find it most helpful and efficient when at least HER2, PD-L1, MMR are already done when patients come for medical oncology visits. When patients have advanced, unresectable disease, we have been requesting an expanded molecular panel that includes...
How do you manage dabrafenib fever?
Tough problem to manage. I've tried numerous strategies with unpredictable success. Prednisone 5mg BID usually works if you want to keep full dose. Otherwise, a dose delay and likely reduction of dab will be necessary.
When should SBRT be offered to oligometastatic bone disease in a patient with prostate cancer?
Recently a multi-institutional analysis set standards for use in prospective assessment of SBRT for use in men with > 1 bone metastasis and up to 3 (data shown below). The Rx was well tolerated and local control was significantly improved if a BED > 100 Gy was utilized. At this time this approach re...
How do you approach muscle invasive bladder cancer in an elderly patient who cannot tolerate chemotherapy?
Although the ideal approach is chemoRT, if patient can't tolerate chemo (if cisplatinum is contraindiacted, 5FU amd MMC is an alternative), then RT to a definitive dose is a reasonable alternative. In the UK randomised study, the control arm of RT alone had about 50% LRC at 2 yrs. For patients with ...
Would you treat a muscle invasive urethral recurrence of bladder cancer with definitive chemoradiation?
Assuming that the urethral tumor is invasive of the prostatic stroma, there are multiple reasonable answers depending upon the patient's age and health status. Remember that stromal invasion is a bad sign and these patients are rarely cured. If the patient is young, but reluctant to consider cystopr...