Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Would you use a hippocampal sparing technique when treating with PCI for a limited stage small cell lung cancer?
This is an important question where the evidence is evolving, and some key trials remain ongoing. Because the data remains in flux, in the ongoing phase 3 SWOG S1827/Maverick trial of MRI surveillance +/- prophylactic cranial irradiation (PCI) for LS and ES-SCLC, where I serve as the PI, hippocampal...
Is the PROTEUS data enough to change your practice in the treatment of patients with high-risk localized or locally advanced prostate cancer?
The question asks if the results of PROTEUS would/should impact practice patterns...let us take a look: ADT is not recommended to be used with radical prostatectomy in prostate cancer by any guideline. Apalutamide or any ARPI are not recommended to be used with RP in prostate cancer in any guideline...
How do you manage toxicities in patients with mPDAC receiving daraxonrasib?
In our experience, we have found several strategies effective: Rash: Doxycycline 100 mg twice daily, avoid all sun exposure and use sunscreen, apply hydrocortisone 2.5% twice daily to face and upper chest and back and neck apply emollient moisturizer to arms, legs, hands, feet at least twice daily....
Before re-challenging a patient with ICI after grade 1-2 pneumonitis, do you re-image to confirm resolution of pneumonitis?
Grade 1 pneumonitis is defined as confined to one lobe of the lung or <25% of the total lung parenchyma, while grade 2 pneumonitis is defined as involving more than one lobe of the lung or 25-50% of the lung parenchyma. Grade 1 pneumonitis is typically an incidental finding on CT in an asymptomatic ...
Is there a role for anti-fibrinolytic agents in patients with hyperfibrinolytic disseminated intravascular coagulation?
DIC is a complex clinicopathologic syndrome. There are no randomized trials to support evidence-based practice. The following principles apply: 1) antifibrinolytics should not be used in patients with organ failure or those that are asymptomatic. One could justify their use in this group of patients...
What are best practices for radiation oncology patient and staff precautions with the COVID-19 pandemic?
COVID Update 1/30/21 Wow, it's been almost a year. Here are some updates from our practices at University of Maryland. We have successfully treated both PUIs and COVID+ patients at all of our practices. We have yet to have a patient to staff (or staff to patient) transmission. We do not break patien...
What is the recommended follow-up/surveillance schedule following organ preservation treatment approach for cT1-2N0 rectal cancer?
Patients with stage I rectal cancer treated with organ preservation require close surveillance to rule out tumor regrowth and local recurrence that may be salvaged with radical surgery. The highest risk of recurrence is within 2 years after completion of neoadjuvant therapy and patients should be fo...
How do you approach treatment of a glioblastoma in pregnancy?
Glioblastoma during pregnancy could be treated safely (to mother and fetus) with certain precautions and modifications. Collaboration and consultation with the patient’s obstetrician are essential. External shielding over the patient’s abdomen during treatment will decrease the external scatter radi...
How do you select first-line therapy for PD-L1-positive metastatic TNBC?
For patients with PD-L1 CPS greater than 10, regardless of germline BRCA1/2 pathogenic variant status, my first-line treatment of choice is pembrolizumab combined with sacituzumab govitecan (SG) or chemotherapy based on the ASCENT-04 trial. In ASCENT-04, SG plus pembrolizumab improved median progres...
Do you recommend chemoradiation following neoadjuvant FOLFIRINOX for resectable pancreatic cancer?
Tough question, with lots of evolution in this area in the past few years. The data would suggest that for borderline resectable pancreatic cancer, there is a benefit in terms of OS from preoperative treatment. For unresectable disease, the small chance of conversion into resectability is worth the ...