Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How do you treat vaginal dryness associated with estrogen deprivation therapy for ER+ and/or PR+ breast cancer?
This is a common problem for many postmenopausal women or those on ovarian suppression. A gynecology exam is important to make sure symptoms are specifically due to estrogen deprivation and not compounded by other causes. A number of options can help including coconut oil/olive oil, vaginal moisturi...
When testing for patients with symptoms of MPN, do you prefer to do JAK2 cascade testing or a leukemia NGS testing panel?
Genetic testing with regard to the MPN can be usefully employed both diagnostically and prognostically. With respect to diagnosis, if an MPN is suspected based on symptoms such as aquagenic pruritis, ocular migraine, erythromelalgia, or the occurrence of an unexplained thrombosis, the first laborato...
When testing for patients with symptoms of MPN, do you prefer to do JAK2 cascade testing or a leukemia NGS testing panel?
Genetic testing with regard to the MPN can be usefully employed both diagnostically and prognostically. With respect to diagnosis, if an MPN is suspected based on symptoms such as aquagenic pruritis, ocular migraine, erythromelalgia, or the occurrence of an unexplained thrombosis, the first laborato...
How should cisplatin be used in head and neck cancer patients with sensorineural hearing loss?
I generally avoid cisplatin entirely in patients with pre-existing sensorineural hearing loss. Instead, I opt for carboplatin-based regimens. If alternative agents are not acceptable (young patient, willing to risk hearing loss for minimal improvement in efficacy, etc.), I carefully consider weekly ...
What would you offer postoperatively for a pt with resected 3 separate HPV+ SCC primaries with pN1 disease with ECE who is cisplatin ineligible?
In view of this patient having ECS and three primaries (including bilateral disease), I would definitely treat postoperatively with chemotherapy in conjunction with radiation therapy. I still favor a platinum-based regimen in view of this patient's neurological toxicity due to previous cisplatin exp...
What is your approach in deciding on definitive therapy for locally advanced, HPV-negative head and neck cancer unsuitable for standard cisplatin based chemo?
The real answer is it depends on the medical oncologist as (s)he typically administers the therapy.It also depends on why cisplatin is contraindicated. Is it an otherwise healthy patient who has renal or hearing issues, or is it an elderly patient with a marginal PS for whom cytotoxics, in general, ...
Would you offer re-irradiation in an adenocarcinoma of the distal esophagus s/p neoadjuvant chemoradiation + Ivor Lewis esophagogastrectomy (ypT3N0) 2 years ago now with TE groove/paraoesophageal LN recurrence with complete response on PET following 8 cycles of FOLFOX?
I generally would offer re-irradiation in this situation. If the lymph node recurrence is completely out of the prior field, it becomes an easier decision and much less technically complex in regard to radiation treatment planning. If out of field, I would treat with 50–50.4 Gy 25–28 fractions with ...
What are your top takeaways from ASCO GI 2026?
GLP1 agonist use is associated with improved outcomes for colorectal cancer in a retrospective United States study. Now we need to incorporate this into randomized trials. I think this also provides more evidence that metabolic syndrome type issues may help explain early-onset colorectal cancers. W...
Which patients, if any, do you revert back to ultrasound screening for HCC after prior diagnosis/definitive treatment of HCC?
I don't revert back to U/S for these patients ever. It's not dissimilar from colorectal cancer screening - once you have colon cancer, it's not appropriate to use iFOBT or stool DNA screening anymore - it's lifelong colonoscopy screening. Likewise, for HCC, I continue to use AFP plus cross-sectional...
In a patient with de novo metastatic RCC s/p Ipi/Nivo with partial response and residual viable RCC on cytoreductive nephrectomy, would you add cabozantinib or other TKI prior to disease progression?
Cytoreductive nephrectomy in asymptomatic patients is a controversial topic. There is some data suggesting clinical benefit to patients, but prospective data in the present checkpoint inhibitor era are needed. Fortunately, there are ongoing prospective clinical trials to provide this much-needed dat...