Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How do you talk with your patients regarding radiographic expectations on surveillance CT after lung SBRT?
In general, especially when I have a discussion about the 3-month follow-up scan and tell patients that the lesion may likely be stable in size, which is often normal, and not to panic. There may also be post-radiation changes that make it more difficult to initially interpret. I think this highligh...
Would you recommend sentinel lymph node biopsy at the time of wide excision for a 3 mm Merkel cell carcinoma of the cheek/lateral canthus?
Unlike melanoma and certainly NMSC, MCC is highly unpredictable in nature, with clinical lesion size having little clinical prognostic value. As such, it appears that SLNB is valuable in many cases for the purposes of prognosis and in determining the need for adjuvant systemic therapy and radiation....
In a patient with metastatic prostate cancer on abiraterone planning to start Radium-223, what is the minimum interval between the last dose of abiraterone and the first dose of Radium?
Update, May 16, 2026. The context of the question changes based on recently published data. These include the safety of combining an androgen receptor pathway inhibitor (ARPI) with Ra-223 and the utility of this approach in the evolving practice of metastatic prostate cancer.Abiraterone has a half-l...
How would you approach anticoagulation for a patient with acute bilateral pulmonary emboli related to malignancy, but with a concomitant cavitary lung mass experiencing episodic, small-volume hemoptysis?
This is an interesting question to which we need to apply the art of medicine, weighing the risks and benefits of treatment. The major fatal events in this exact scenario are: Recurrent PE from undertreatment. Sudden massive hemoptysis after aggressive anticoagulation. The physician's management s...
How would you approach anticoagulation for a patient with acute bilateral pulmonary emboli related to malignancy, but with a concomitant cavitary lung mass experiencing episodic, small-volume hemoptysis?
This is an interesting question to which we need to apply the art of medicine, weighing the risks and benefits of treatment. The major fatal events in this exact scenario are: Recurrent PE from undertreatment. Sudden massive hemoptysis after aggressive anticoagulation. The physician's management s...
How long would you anticoagulate a patient with recurrent VTE who has ongoing risk factors for intracranial bleeding?
In general, my preferred agent outside of the inpatient setting in patients with a risk of intracranial bleeding is LMWH. In the inpatient setting, utilizing a bivalirudin or heparin gtt is most appropriate. I would monitor carefully, including potentially imaging 24 hours after the therapeutic anti...
Would you recommend the SOFT/TEXT adjuvant approach of ovarian suppression/AI in a premenopausal woman with high-risk disease who still desires to have a pregnancy?
In the SOFT trial, the disease-free survival impact of adding ovarian suppression to hormonal therapy was not statistically significant in the overall population, but was superior in higher risk patients, including those who received chemotherapy. While we typically do not guide treatment based on s...
Can immune checkpoint inhibitors be safely given in a patient with chronic GVHD?
If the patient has active chronic GVHD the risk-benefit ratio of immune checkpoint blockade needs to be carefully assessed since there are well documented instances of severe GVHD flairs or immune-related adverse effects - in a patient on chronic immune suppression and quiescent GVHD we recommend no...
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...
What chemotherapy would you consider to treat platinum resistant high grade serous ovarian cancer in patients with a low grade MDS from prior platinum/PARPi?
Before making a recommendation to this patient, a basic understanding of treatment related MDS/AML is needed, along with a clarification of the meaning of “low risk of progression to acute myeloid leukemia (AML)”. My main goal would be to avoid therapy with a demonstrated risk of treatment related M...