Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Do you routinely add anti-hormonal therapy to HER2 directed therapy in a patient with ER+ HER2+ breast cancer?
That is my usual practice.As soon as the cytotoxic part of chemo is over,patient would go on AI. I consider their long term cure and the fact that HER 2 has been countered effectively places even more importance on appropriate Hormonal strategy for cure.
What is your approach to treating metastatic prostate cancer with primary resistance to GnRH analogues or early CRPC?
There is no one correct answer for every patient. In general, patients who are primarily resistant to GnRH or who develop early CRPC and who have not received docetaxel in the hormone-sensitive setting, would be good candidates to receive docetaxel. For those who are elderly or frail, I would consi...
When do you consider local therapies (i.e. TACE) in patients with intrahepatic cholangiocarcinoma who do not tolerate or respond to chemothearpy or who are not surgical candidates?
The treatment of choice would be EBRT, ideally delivered to ablative doses or at least over 80 BED (Tao et al., PMID 26503201).For LC and OS benefits. This is an NCCN based recommendation based off of retrospective and single arm prospective (Hong et al., PMID 26668346) data. Two year LC 94% of IHCC...
How would you manage a patient with surgically resected T3N1 NSCLC who is found to have one small brain metastasis on staging MRI?
For adjuvant chemotherapy, this is a difficult question for which there is no evidence-based answer, really. The "textbook" answer is that this is metastatic disease, and adjuvant therapy has only been proven for early stage disease. However, since there is still a reasonable chance of a cure after ...
Is there any data to support to use of Brentuximab in the up-front setting in the treatment of Hodgkin lymphomas?
Currently, Brentuximab vedotin is only approved in Hodgkin lymphoma 1) following failure of 2 multi-agent regimens or ASCT and 2) for post-ASCT maintenance. However, there are several ongoing phase II and III trials in both the US and EU examining Brentuximab vedotin in the up-front setting. The lar...
When do you offer consolidation chemotherapy for patients receiving chemoradiation for locally advanced NSCLC?
I rarely use consolidation therapy. When I do, it is usually because of lapses in or missed chemoRT treatments. We have two randomized studies that show no benefit to consolidation therapy.
In patients with metastatic NSCLC, would you consider atezolizumab after failure of nivolumab or pembrolizumab?
Do you ever withhold PCI for elderly patients with limited stage SCLC?
In my opinion, the findings by Takahashi et al, Lancet 2017 regarding the lack of survival benefit of PCI as compared to MRI observation in patients with extensive SCLC has re-opened the question of the survival benefit of PCI in limited SCLC in the modern imaging era. Hopefully, a phase III study o...
When TPN is a barrier to enrollment in hospice for an eligible cancer patient with an irreversible malignant bowel obstruction, how do you approach the conversation about discontinuation of TPN?
This is such a tough question with no great answer. With any difficult conversation like this, I usually take this approach: 1) Understand what the patient's goals are. ("What's most important to you?") 2) Usually they say living as long as possible/as well as possible 3) Acknowledge that goal as r...