Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Would you offer adjuvant TKI to patients with Stage III, EGFR-mutant NSCLC after standard chemoradiation?
I would definitely not use adjuvant erlotinib after either surgery or radiation at the current time. The data do not support this, and it is has significant toxicity. Not statistically significant means that the data are likely to have come out this way by chance. The disease free survival tended to...
Do you routinely recommend prophylactic cranial irradiation for stage I small-cell lung cancers treated with lobectomy and adjuvant chemotherapy?
PCI was 'associated' with better long-term survival even in stage 1, and age and size factors do not seem to matter. However, as the information gets divided, fewer patients fall into each cohort.A recent study published in the JCO, analyzing over 1,000 patients in the NCDB, found that thoracic radi...
Is there any role for radium-223 early in the course of castration-resistant prostate cancer with bone metastases?
In the ALSYMPCA trial, there was a demonstrated benefit of radium-223 on survival and skeletal event delay, regardless of prior docetaxel (Hoskin et al Lancet Oncol 2014), indicating that it is not necessary to give docetaxel first before radium and that radium has clear activity in earlier mCRPC (s...
For high risk, stage I, non-seminomatous testicular germ cell tumors, are there particular circumstances under which RPLND is clearly preferred over chemotherapy or surveillance?
There are few indications for primary RPLND in pure nonseminomatous CSI. The only one I can currently think of is someone who has a strong contraindication to ever receiving chemotherapy.... renal failure or the like. The only time I consider it general is for patients with high risk Leydig or Serto...
For a patient with inflammatory breast cancer after standard initial systemic therapy with only a partial response, do you recommend more systemic therapy, pre-operative radiation, or proceed to modified radical mastectomy?
The systemic therapy question was addressed and partly answered with the CreateX trial. In that 900 patient trial there was an improvement in DFS and OS with adjuvant capecitabine. The current EA1131 explores this question further, directly comparing cape to platinum. The randomization is stratified...
Should FISH studies be repeated when CLL patients under active surveillance have progressive disease warranting treatment?
FISH studies should be performed on a newly diagnosed patient with CLL as well as those who have progressive disease and now warrant additional therapy. It is important to identify those patients who may have acquired additional cytogenetic abnormalities due to clonal evolution/resistance/etc as thi...
When should intermittent androgen deprivation vs continuous androgen deprivation be used for the treatment of prostate cancer?
I think the question posed and the patient example are really 2 different questions. To address the title question, let me call your attention to a recent article in the JCO 34: 280-5, 2016, and an accompanying editorial, which review this issue in detail. The authors point out that there are signif...
Would you consider SBRT for an inoperable T1-T2 N0 SCLC?
The concept of using SBRT in the setting of inoperable early-stage node negative small cell lung cancer (SCLC) is interesting and replicates the concept of SBRT as a surgical surrogate. In other words, SBRT is used to manage the primary lesion, as with early-stage non-small cell lung cancer (NSCLC)....
Is there a role for adjuvant docetaxel in patients with high-risk localized prostate cancer who elect for prostatectomy?
Currently, there is no data to support the use of adjuvant docetaxel following radical prostatectomy. Given that these are two entirely different treatments in different patient populations, there is no rationale for extrapolating the results from RTOG0521 to a post-surgical (even if high-risk) popu...
How would you follow patients with differentiated thyroid cancer that no longer picks up iodine after thyroidectomy and RAI, and have thyroglobulin antibodies?
The presence of antibodies makes measuring the thyroglobulin level essentailly inaccurate. PET imaging may have a role though clear data on its utlity is limited (and it's expensive). Physical exams and Ultrasonography is the best way of monitoring the disease state from a surveillance point. For sy...