Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Would you recommend PMRT for a patient with a right breast mastectomy with closest margin less than 0.1cm?
I would consider this if there were other high risk factors like T2 disease, high grade or LVSI. In absence of these factors, favor systemic treatment alone. Here is one reference.
What are the first line treatment options in HCC patients with significant baseline proteinuria?
Tough problem! Treatment of advanced HCC is quite challenging since medical oncologists have to account for the compromised liver function (due to the underlying liver disease) over and beyond the disease burden, when making treatment decisions. Therefore, treatment decisions are often made after we...
How do you treat a patient with a history of clinical stage IIb cN2, mixed germ cell embryonal carcinoma treated with BEP and RPLND five years ago, who now has signet ring cell adenocarcinoma with abdominal carcinomatosis with an unknown primary?
My experience would suggest that this is a second primary unrelated to his germ cell tumor. I would predict that the i12p will be negative and, if it were available, the MiR371 would be negative. I presume his current AFP and HCG are negative. I have seen this situation once with a young man almost ...
How would you approach a patient with a locoregional recurrence TNBC who requires neoadjuvant treatment?
My assumption is that the patient developed this currently unresectable LRR after completing neoadjuvant chemotherapy and surgery, and has to be considered at high risk for both local complications, which is why you want to administer 'neoadjuvant' therapy (although I'm not sure that the term is app...
What is your treatment approach for metastatic squamous carcinoma of the prostate?
There are limited data to guide the management of metastatic squamous cell cancer of the prostate. Outside clinical trials, I have typically treated patients extrapolating from squamous cell cancer of the lung /head and neck literature and have seen responses with gem and cisplatin, 5 FU, pembrolizu...
How do you sequence short course radiation for locally advanced rectal cancer when using the total neoadjuvant approach?
Short answer: No, there is no data suggesting that this regimen and its longer wait is detrimental to operative morbidity for rectal cancer. Long answer: The concern about the delay from TNT, whether short course radiation->chemotherapy OR chemoradiation->chemotherapy prior to surgery has been addre...
What lifestyle changes (if any) do you recommend to patients and caregivers regarding the bodily fluids of patients receiving systemic therapy?
For recommendations related to reproduction (both genders) and lactation, the USPI (a.k.a. FDA label) is a great place to start. Specifically, I refer to subsections 8.1 Pregnancy, 8.2 Lactation, and 8.3 Females and Males of Reproductive Potential of the "Use in Specific Populations" section. These ...
Do you routinely prescribe anticoagulation for patients on active chemotherapy?
This is dependent on the risk factors of the patient for the development of VTE. Recently published ASCO guidelines (JCO 2019) incorporated the additional recommendation of VTE prophylaxis for high risk outpatients receiving chemotherapy with either eliquis, xarelto, or LMWH. The Khorana scoring sys...
How long should breast cancer patients whose surgeries are delayed due to COVID-19 remain on neoadjuvant endocrine therapy?
How long to continue neoadjuvant endocrine therapy (NET) when it was initiated for the purposes of COVID-19 management depends on several variables, including whether the tumor is at least stable on NET (if not, then conversion to surgery or chemotherapy is appropriate), and what the COVID-19 trajec...
Should new patients requiring chemotherapy be tested for COVID-19 prior to starting treatment?
At Vanderbilt, we are testing asymptomatic patients for COVID if they are getting a 'high-risk' regimen, which we have empirically defined as: CAR-T cells, BMT, combined chemo/XRT, regimens normally requiring growth factor support etc. There are not great data to advise on specific risks for specifi...