Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How do you choose among the available PD-1/PDL-1 inhibitors approved for metastatic bladder cancer?
This is an evolving field. While the thought had been all the drugs were likely equivalent in efficacy (with no head to head trials) this has changed in the past week. Roche had a press release in which they announced the Phase III IMvigor211 study that evaluated atezolizumab in people with locally ...
Are CHEK2 mutations a contraindication for breast conservation therapy with lumpectomy + RT?
Among women with early-stage breast cancer and moderate penetrance breast cancer susceptibility genes, such as CHEK2, decisions about breast surgery are largely based upon personal preferences. According to data from large population-based studies, women with CHEK2 pathogenic variants have about a 2...
Should 3 years of adjuvant osimertinib be the standard of care for resected Stage IB-IIIA EGFRm NSCLC?
Since my initial response to this question, the ADAURA study has been fully published (NEJM 383:1711, 2020) and the FDA has approved osimertinib as adjuvant therapy for people with resected NSCLC harboring an EGFR sensitizing mutation. However, neither of these events has altered my opinion that des...
How do you decide on the duration of endocrine therapy for premenopausal women who receive chemotherapy and AI/ovarian suppression according to TEXT/SOFT?
Women who have a higher than average risk of recurrence (those who receive chemotherapy, younger than 35 Years, stages II or III ....) derive the most benefit from endocrine therapy +ovarian suppression (using monthly GNRH agonists) for 5 years based on TEXT and SOFT in DFS. The joint analysis of SO...
Do you refer all of your patients for EGD prior to initiation of atezolizumab/bevacizumab for advanced HCC?
Per the trial, this was required within 6 months of starting the study. However, in practice, I don't know that this strict rule would be necessary. For example, what if an EGD was done 10 months ago without varices? I don't think I would feel strongly about this. Similarly, if we could get one shor...
How do you manage a muscle-invasive bladder cancer patient who received neoadjuvant cisplatin-based chemotherapy but has a positive margin post-operatively?
While no trial has tested adjuvant RT plus nivolumab in margin-positive post-cystectomy bladder cancer, and this remains an extrapolation, I would consider adjuvant pelvic RT as radiation alone (cystectomy bed/pelvic nodes 45–50.4 Gy, boost the involved margin to 54–60 Gy), consistent with how NCCN ...
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...
Would you consider use of PARP inhibitors in patients with metastatic breast cancer with moderate penetrance germline mutations such as CHEK2, ATM, RAD51?
In the Olaparib Expanded (TBCRC 048) study published by @Dr. First Last in JCO, there were no responses to olaparib in metastatic breast cancer with germline or somatic CHEK2 or ATM pathogenic variants (mutations). In contrast, responses were seen in metastatic breast cancer with PALB2 pathogenic va...
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...
Do you use MRD testing to guide maintenance therapy discontinuation in newly diagnosed non-high risk myeloma patients?
Major bias, incoming!The short answer is: yes, I use MRD to guide de-escalation and ultimately discontinuation in standard-risk patients with myeloma.Much of that sentiment comes from our work at the University of Chicago called MRD2STOP, where we allow patients to stop treatment if they are sustain...