Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Do you treat regional nodes for SLN-determined node negative patients with early stage breast cancer in a medial location?
High grade. Triple neg.
Given the emerging benefit of neoadjuvant immune checkpoint inhibitors in selected patients with cutaneous melanoma, when should lymph node basin ultrasound or cross-sectional imaging (CT/PET) be considered prior to wide local excision (WLE) with or without sentinel lymph node biopsy (SLNB) in patients with clinically node-negative disease?
As the current neoadjuvant IO data for melanoma are mainly from SWOG 1801 and NADINA trials, I would say the main patient population to focus on baseline staging scans (i.e., PET or CT) would be those with resectable stage III or IV disease. As it’s not possible to know whether lymph nodes have micr...
Do you use G-CSF for a patient with ALL admitted for febrile neutropenia with prolonged count recovery?
I agree with this response. To highlight one other consideration: G-CSF is not routinely given during COG-based, pediatric-inspired therapy like the C10403 regimen (Stock et al., PMID 30658992). However, when patients treated with this approach in our system develop neutropenic fever, we will usuall...
In pediatric patients with newly diagnosed B-cell ALL and underlying Lynch syndrome, how does the MMR deficiency inform your treatment planning and survivorship surveillance?
Treat B-cell ALL with chemotherapy appropriate for risk category and usual follow-up. MRI Brain Q 6 months up to age 20, then annually Colonoscopy annually starting at age 6 years Upper endoscopy at age 10 years and annually Whole body low dose MRI annually Physical examination and skin exam every ...
In pediatric patients with newly diagnosed B-cell ALL and underlying Lynch syndrome, how does the MMR deficiency inform your treatment planning and survivorship surveillance?
Treat B-cell ALL with chemotherapy appropriate for risk category and usual follow-up. MRI Brain Q 6 months up to age 20, then annually Colonoscopy annually starting at age 6 years Upper endoscopy at age 10 years and annually Whole body low dose MRI annually Physical examination and skin exam every ...
Under what circumstances do you consider a biopsy for a patient with a new brain lesion who is undergoing active systemic cancer treatment?
Indications for biopsy would be rare: First - if the brain lesion is dural-based and slow-growing, and the patient has excellent systemic control. Second - if the brain lesions are progressing despite standard radiation therapy. Third - if control of CNS disease is being done using CNS-penetrating t...
How do you sequence hypofractionated radiation and systemic therapy for patients with unresectable cholangiocarcinoma?
I have generally cared for patients analogously to that done in the initial NRG GI001 or ABC07 trial designs with the use of initial systemic therapy for 3-6 months followed by consolidative RT targeting a BED > 80.5, assuming a/b ratio of 10 Gy. Tao et al., PMID 26503201 In my practice, it’s most c...
Is it safe to use medroxyprogesterone for vasomotor flushing?
There are many options for management of hot flashes including venflaxine and gabapentin being most frequently used as well as some data on cognitive behavioral therapy, oxybutynin, and acupuncture. For the most refractory cases, I do discuss medoroxyprogesterone 400 mg IM as a one time option based...
What are the recommended second-line treatment options for patients with metastatic HER2+ breast cancer who have received frontline trastuzumab deruxtecan (T-DXd)?
There is currently limited direct evidence to guide optimal sequencing after frontline trastuzumab deruxtecan, so second-line treatment decisions are individualized. In many cases, the HER2CLIMB regimen with tucatinib, capecitabine, and trastuzumab is an appealing option, particularly for patients w...
How are you approaching patient selection for relacorilant + nab-paclitaxel (ROSELLA) in platinum-resistant ovarian cancer?
Relacorilant + nab-paclitaxel is now FDA-approved as of March 2026 and NCCN-listed as a preferred regimen for platinum-resistant epithelial ovarian, fallopian tube, or primary peritoneal cancer, and notably does not require biomarker selection — making patient selection primarily based on clinical a...