Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How do you manage postoperative residual disease after neoadjuvant chemoradiotherapy and surgery for a patient with locally advanced esophageal or GE junction adenocarcinoma?
Do you recommend adjuvant chemoradiation for T2N0 gastric adenocarcinoma?
In general, we do not recommend adjuvant RT for T2N0 gastric adenocarcinomas unless other adverse factors were present. The long term results of the INT-0116 trial stated patients were T3-4 or node positive, but the initial report says stages IB-IV. Notably, the studied allowed T1N1 but not T2N0. Al...
Other than part of a clinical trial or for its FDA-approved indication (second-line therapy for metastatic squamous-cell NSCLC), when do you offer nivolumab to your patients with NSCLC?
How long do you continue maintenance chemotherapy for metastatic non-small cell lung cancer in patients who have achieved a radiographic CR?
This is a very difficult question. I think we need to keep in mind that less than 5% of all advanced stage non-small cell lung cancer patients acheive a CR with systemic chemotherapy. In addition, most of the maintenance studies published don't separate out CR and PR when discussing responses to the...
In light of CHAARTED and STAMPEDE, should all men with newly-diagnosed, treatment-naive metastatic prostate cancer be treated with chemohormonal therapy?
This is an evolving answer but presently I do offer 6 cycles of docetaxel to men with M1 (not N1) CSPC who are initiating or who have recently initiated ADT. This would include men who present with M1 disease but also men with rapidly recurrent mCSPC who are hormone naive. There appears to be a grea...
Should bone-directed agents, such as denosumab or zoledronic acid, be given when patients are being treated with radium-223?
In ALSYMPCA, bisphosphonate use at study entry was associated with a delay in symptomatic skeletal events (Sartor, et al. Lancet Oncol 2014; 15(7) 738-46). Based on this, osteoclast-targeted agents (i.e. zoledronic acid and denosumab) should be offered to patients with mCRPC that will receive radium...
What chemotherapy regimen is best suited for patients with platinum-refractory metastatic bladder cancer who have good or excellent performance status?
I would try to get patient to a pd1/pdl1 study or try to get it off-label. Early results are promising for 1/3 of patients.
At what point would Radium-223 dicholoride treatment be the best management for a patient with established metastatic prostate cancer with an elevated PSA and symptomatic bone pain with corresponding bone lesions on imaging?
At present, based on the randomised trial, it is approved for castrate resistant prostate cancer (can be chemo naive) with symptomatic bone only disease. In that situation, it improves all skeletal related events and survival and should be an indication to talk about this treatment. However, in prac...
Is there a role for post-treatment PET/CT following chemoRT for Stage III NSCLC?
The data from RTOG 0235 are certainly intriguing, but I don't think we have sufficient information to employ this in routine clinical practice.In fact, I think there are quite a few challenges, including, but not limited to:1. What is the true sensitivity for post-CRT PET/CT for LR failure? This was...
Do you ever recommend concurrent chemotherapy for high risk squamous cell skin cancer radiation?
Yes. The dose of radiation depends on the treatment scenario (adjuvant vs definitive). I generally follow NCCN guidelines, and give the same dose whether or not chemo is given. For bulky tumors, I might use a higher radiation dose if no chemotherapy is given. In general, the radiation dose is relat...