Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
What is the optimal management of recurrent seminoma with small volume retroperitoneal disease initially managed with surveillance?
The question is how to manage pathologic confirmed CSII seminoma. If the nodal volume is on the larger side (> 3 or so cm), most experts would treat those patients with BEP X 3 with a very high cure rate, with very low likelihood of requiring any post-chemotherapy interventions. Most experts in the...
What is the role of radiation treatment of stage IA ALK negative anaplastic large cell lymphoma?
It would be helpful to know the site of origin. Most stage I ALCL alk neg would be in the skin, in which case RT is the treatment of choice with little role for chemotherapy. Stage I ALCL, other then skin, would be quite rare with no data to guide us, except that we know response to chemotherapy for...
How do you approach the treatment of uT1N0M0 gastric cancer if the EUS is consistent with linitis plastica?
Linitis plástica means that the entire stomach is involved with cancer therefore treatment would be mainly palliative with systemic chemotherapy for stage IV disease
What is your approach to patients with stage III melanoma now that the FDA has approved adjuvant ipilimumab for high risk stage III melanoma patients?
The newly approved ipilimumab high-dose adjuvant modality needs to be presented to patients with stage III disease in the upper risk categories for which the trial showed reduction in relapse risk at analysis 18 months ago, as presented to ASCO 2014 and subsequently published. Unfortunately, there i...
Based on data from CREATE-X/JBCRG-04, would you consider adjuvant capecitabine in breast cancer patients treated with neoadjuvant chemotherapy who do not achieve a pCR?
Yes, 6-8 cycles of adjuvant capecitabine has been shown to improve survival in one randomized trial and therefore should be offered and disused with a patient. If capecitabine is given it could be given after surgery followed by radiation therapy or radiation may be completed first. Both options wer...
Based on the recent disease-free survival results from ABCSG-18 presented at San Antonio, do you favor the use of Denosumab in the adjuvant setting?
I'll give you the simple answer first - YES. In those receiving AI adjuvant therapy (whether postmenopasual or pre with ovarian suppression/ablation). We've struggled with how (and whether) to use bisphosphonates in the adjuvant setting. The meta-analysis found a significant improvement of similar m...
Which patients would you offer a watch-and-wait approach versus surgical resection after chemoradiotherapy for patients with rectal cancer?
I would never offer watch and wait as an alternative, even in the patients with an apparent clinical complete response, and I would attempt to dissuade any patient from pursuing this approach. Even after apparent clinical complete response, we frequently see pathologic evidence of residual disease. ...
Is there a role for docetaxel for men with high risk prostate cancer receiving radiation and androgen deprivation therapy?
Standard of care for high risk localized prostate cancer remains radiation and long term androgen deprivation therapy. To date, there are no trials that have demonstrated an overall survival benefit with the addition of chemotherapy. Given the potential toxicity of adding chemotherapy, this should n...
Is there evidence to support routine use of adjuvant chemotherapy for resected rectal cancer treated with pre-operative chemoradiation?
We settled this question in 1985 with the GITSG study showing chemo, or radiation were better than observation and the combination had the best survival (GITSG, NEJM 312,1465, 1985). Whether you administer radiation or systemic therapy before or after surgery is irrelevant but all three modalities h...
Do you transfuse anemic head and neck cancer patients undergoing chemoradiation?
No, never have.