Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How do you treat metastatic bladder cancer with extensive squamous differentiation in a cisplatin-ineligible patient?
The impetus for the question is presumably the impact of squamous differentiation on what has become the standard for metastatic urothelial cancer, namely enfortumab vedotin combined with pembrolizumab. Trials leading to the approval in the metastatic space as well as the perioperative space all req...
Do you routinely check tumor genomics, including POLE status for new endometrial cancers?
Update provided March 23, 2026This is a great question for two main reasons: Resource utilization What am I going to do with the data I would choose to send POLE testing on patients where you think the data might impact your care... the challenge with that is that we lack strong prospective data to ...
How do you plan to integrate exercise programs after adjuvant chemotherapy in patients with colon cancer, given the results of the CHALLENGE trial?
The CHALLENGE study demonstrated that structured exercise following adjuvant chemotherapy significantly benefits patients with resected high-risk stage II or stage III colon cancer. The study's success hinged on its mandatory behavioral-support sessions. Unlike the control arm, which received only h...
How do you choose between axicabtagene ciloleucel and tisagenlecleucel in patients with follicular lymphoma for whom you are recommending CAR T-cell therapy?
This is an area of uncertainty. There are no head-to-head data to bring to bear, of course (and, if there were, you probably wouldn’t need to ask). The toxicity profile of the two cells is clearly different, with lower rates of severe toxicity with tisacel than with axicel. As neither product has be...
How do you choose between axicabtagene ciloleucel and tisagenlecleucel in patients with follicular lymphoma for whom you are recommending CAR T-cell therapy?
This is an area of uncertainty. There are no head-to-head data to bring to bear, of course (and, if there were, you probably wouldn’t need to ask). The toxicity profile of the two cells is clearly different, with lower rates of severe toxicity with tisacel than with axicel. As neither product has be...
Should we consider radiation therapy for patients with N2 EGFRm NSCLC who will receive osimertinib, though RT was excluded on ADAURA?
For an EGFR-mutant N2 disease, we favor adjuvant chemotherapy (OS benefit) and/or adjuvant TKI based on ADAURA trial (DFS survival). The only prospective data regarding the use of adjuvant radiotherapy comes from a phase III trial, Lung Adjuvant Radiotherapy Trial (Lung-ART), where patients were ran...
Is there any role for "adjuvant" therapy for completely resected oligometastatic RCC?
The data re: adjuvant therapy for either high risk (bulky or node positive primary renal cell cancer) or completely resected metastatic renal cell cancer (either synchronous or metachronous) remains largely negative. Trials conducted with cytokines or with a variety of multi kinase inhibitors (sunit...
How would you approach management of a large, fungating squamous cell carcinoma of the auricle if surgical management is not desired by the patient?
For a tumor this size and with cartilage invasion, I would recommend starting with induction cemiplimab to best response (generally 4-6 cycles), followed by consolidative RT, generally electrons. Prior to starting the immunotherapy, I would stage the neck with a contrast CT scan, as tumors of this s...
Are there any online or publicly available pelvic floor physical therapy resources you regularly use or offer to patients?
PFPT is a great adjunct to many treatment regimens for pelvic conditions, such as urge or stress incontinence, dyspareunia, and pelvic pain. While supervised PFPT is outstanding, many women cannot maintain regular follow-up sessions, especially if they have to travel. I direct my patients to YouTube...
What is your preferred third-line therapy for metastatic colon cancer, RAS-WT, MSS, low TMB, with no targetable alterations?
My preferred treatment in this scenario is trifluridine-tipiracil plus bevacizumab. This is based on the favorable side-effect profile of this regimen (compared to alternatives) and the evidence from the SUNLIGHT trial, which showed that bevacizumab plus trifluridine-tipiracil was superior to triflu...