Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Would you recommend anticoagulation prophylaxis for a pediatric patient admitted with COVID-19?
COVID-19 disease in children seems to be less severe than adults based on the current literature and our personal experience at Children's Hospitals. Among adults, the coagulopathy is beginning to be described with elevated inflammatory markers and other markers of coagulation activation, including ...
How have you incorporated gene expression profiling tests for melanoma or SCC into your practice and has it changed your approach to treatment and/or monitoring?
This is a controversial topic for sure, but most emerging technologies in medicine are. I do use gene-expression profiling in the treatment of cutaneous SCC and invasive melanoma. My theoretical framework for using GEP testing is that it is a forward looking test, while clinical staging is backward...
How would you approach systemic treatment of oligometastatic recurrence following surgical removal of the single area of metastasis in a patient with ER+ (20-30%), PR-negative, HER2-negative breast cancer?
I would most likely start the patient on endocrine therapy and a CDK4/6 inhibitor. Even though the response rate is lower with this approach in patients with lower hormone receptor-positive breast cancer, it can still be a reasonable option, and it would avoid chemotherapy-related risks and toxiciti...
Would you continue tarlatamab in CNS-only progression of small cell cancer if there is no systemic disease?
I would absolutely continue tarlatamab in this scenario. While there is evidence of at least some activity of tarlatamab in the CNS (e.g., Zhang et al., PMID 40126456), the effect can be transient, suggesting that intra- and extracranial discrepancy is possible/probable. I would handle isolated, oli...
In which patients with stage 1 triple negative breast cancer would you utilize neoadjuvant chemotherapy?
Overall, neoadjuvant administration of chemotherapy is appropriate whenever adjuvant chemotherapy is indicated. There is clinical benefit from administering chemotherapy to cancers > 2cm because patients are often end up with smaller surgical resection than in the absence of neoadjuvant chemotherapy...
Should axillary imaging be routinely performed in all patients with a new diagnosis of breast cancer?
This issue has been debated but I would argue that patients with a new diagnosis of breast cancer should not undergo routine screening US of the axilla to look for clinically occult disease. The axillary US should be limited to diagnostic imaging for clinically suspicious nodes on clinical exam or b...
When will you prescribe 3 v. 6 months of FOLFOX or XELOX for the adjuvant treatment of colon cancer?
This set of studies will do more to reduce toxicity for patients than any other studies presented at ASCO this year. Based on these results, I plan on treating stage III patients as follows: 1. For T4 and/or N2 patients, I will continue to recommend FOLFOX or CAPOX for 6 months, and continue to adju...
Are you using maintenance lurbinectedin with immunotherapy in the first-line treatment of extensive stage small cell lung cancer?
Yes. I am encouraged by the recent IMforte data demonstrating both PFS and OS benefit with the addition of maintenance lurbinectedin (Paz-Ares, Lancet 2025). Landmark PFS at 6 months approximately doubled (42% vs 19%) and OS at 1 year was 56% vs 44% with atezo+lurbi vs atezo alone. The rate of attri...
In which patients with atypical HUS would you consider eculizumab discontinuation?
My approach to eculizumab cessation in aHUS is to at least consider cessation in all patients not only given the high cost of the drug, but also given the risk of meningococcemia, which is incompletely protected against by vaccines.In treating aHUS, I initiate eculizumab (and preventive therapy for ...
Would you recommend the SOFT/TEXT adjuvant approach of ovarian suppression/AI in a premenopausal woman with high-risk disease who still desires to have a pregnancy?
In the SOFT trial, the disease-free survival impact of adding ovarian suppression to hormonal therapy was not statistically significant in the overall population, but was superior in higher risk patients, including those who received chemotherapy. While we typically do not guide treatment based on s...