Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Do you ever consider referring fit patients with NSCLC and oligometastatic disease isolated to the pleura for extrapleural pneumonectomy?
I do not believe that there is a role for EPP in NSCLC patients with pleural nodules. The morbidity of the surgery is quite high, and the chance of cure is minimal. This is not a situation for which the term oligometastatic disease is truly appropriate. On the other hand, if the patient has pain fro...
How do you approach patients with low ER positive (1 - 9%) breast cancer?
The EBCTCG meta-analysis on adjuvant tamoxifen found benefit with tamoxifen use across all subgroups of ER expression, including the low expressors (1-9%). The absolute benefit of tamoxifen may not be significantly high. In my practice, I do offer anti-estrogen therapy in such a setting, but have a ...
How do you approach the management of borderline resectable pancreatic cancer in patients with superior mesenteric artery vs vein abutment ?
This is an area where treatment paradigms are in flux. If there is no vascular abutment our usual policy is resection followed by adjuvant treatment. With the augmented response rates being seen with FOLFOXIRI and gemcitabine + nab paclitaxel there is a better chance that tumor shrinkage off of vasc...
What treatment options would you consider for a patient with an ECOG PS of 0 with metastatic non-uterine leiomyosarcoma who has progressed on all standard systemic therapies including anthracycline, gemcitabine, taxane, vinorelbine, pazopanib, temozolomide, and trabectidin?
The correct answer is a phase 1 clinical trial, or perhaps compassionate use immunotherapy.
How do you counsel men with prostate cancer on the cardiovascular risks of androgen deprivation therapy?
This is a complex issue and depends on the specific setting (concurrent with XRT), the risk of the patient, and the specific CV risks of that patient. In the metastatic setting, there is almost never a contraindication to hormonal therapy given that prostate cancer is the likely cause of death in th...
Do you routinely perform molecular profiling for potentially actionable targets in patients with advanced pancreatic cancer?
In our practice, we reserve the use of molecular broad NGS testing to our patients with metastatic disease, usually at time of first progression. Unfortunately not too many patients will have an actionable mutation, as the most common ones would be in KRAS and TP53. CDKN2A is the most frequently ina...
How do you manage musculoskeletal pain in men receiving androgen deprivation therapy for non-metastatic prostate cancer?
This a very good question. Because bone pain can be a symptom of "benign" bone health issues without bone metastasis and because of the patient population demographics including risk factors, we obtain baseline bone health screening on most patients who must undergo Androgen Deprivation Therapy (ADT...
Which chemotherapy regimen would you choose for a female adolescent with favorable prognosis stage I-II Classical Hodgkin lymphoma, assuming the patient prefers not to do IFRT if the initial PET response is good?
How do you counsel premenopausal women with BRCA1 or BRCA2 mutations on the need for bilateral oopherectomy?
I typically mirror the NCCN guidelines in this area. For those with BRCA 1 mutations, I recommend RRBSO between age 35-40 after completion of childbearing. Because those with BRCA2 mutations typically have onset of ovarian cancer later, it is reasonable to delay until age 40-45. Counseling needs to ...
Do you use anti-PD-1/anti-PD-L1 therapies in lung cancer patients with a prior history of radiation pneumonitis?
I have used anti-PD-1 directed therapies in patients with a prior history of radiation pneumonitis. The history had excluded her from one clinical trial of these agents but not another that is also combining the anti-PD-1 directed therapy with a CTLA-4 agent. If someone is on steroids for a current...