Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How do you treat de novo metastatic hepatocellular carcinoma in a non-cirrhotic patient with a prior orthotopic liver transplant for hepatitis B now on chronic immunosuppression?
What adjuvant treatment would you use for a cisplatin ineligible, node positive, upper tract urothelial cancer patient after radical nephroureterectomy?
Based on the recent POUT trial, there is no benefit in substituting cisplatin with carboplatin. In fact, node positive patients tended to do worse even with chemotherapy. I routinely consider adjuvant IO trials for these patients like AMBASSADOR. If patient is not able to participate in trials, it m...
How do you manage elderly patients with borderline PS and ER+ inflammatory breast cancer without metastasis?
Consideration of chemotherapy in this particular case will depend on a number of factors including: specific commodities, cardiac risk factors , and overall performance status. CARG tox calculator may help in teasing out potential for toxicity vs. benefit from treatment. Biological characteristics o...
In a patient with liver metastases from a pancreatic NET, that have been successfully treated with ablation by interventional radiology, would you resect the primary pancreas lesion?
Grade absolutely matters here. The number of liver mets and other extent of disease also matter. For low-grade pancreatic neuroendocrine tumors (PNET) with liver only metastases who are good candidates for surgery, resection can be considered. Benefit was seen in this study with locally advanced PNE...
How would you treat DLBCL of the terminal ileum in an otherwise healthy patient?
Primary intestinal Diffuse large B cell lymphoma (PI-DLBCL), even if found incidentally on a screening colonoscopy in an asymptomatic patient, should be treated with systemic chemotherapy similar to what is done with nodal DLBCL. With this approach, the prognosis for PI-DLBCL is very good based on t...
Would you treat prostate cancer with hormone sensitive metastatic recurrence (after local treatment) the same as de novo metastatic hormone sensitive disease?
Yes, most of the phase 3 trials (ARCHES, ENZAMET, TITAN, STAMPEDE) permitted relapsed mHSPC patients in addition to de novo mHSPC patients. LATITUDE was the only trial that required newly diagnosed patients with mHSPC. For the AR inhibitors, a similar benefit in delaying radiographic progression or ...
In transplant-eligible, fit patients with primary refractory myeloma, what is the optimal timing for stem cell collection?
In fit patients with less than a partial response to induction therapy, i.e. primary refractory, the optimal timing for stem cell collection is NEVER. If they don't respond to three drug induction (proteasome inhibitor + IMiD + steroid), they are unlikely to respond durably to a standard high dose m...
Would you rather start radiation for Stage III NSCLC in the middle of a chemotherapy cycle or wait for the 2nd cycle if it could not be started on cycle 1 day 1?
While we all strive to provide streamlined multidisciplinary care, it may not always be possible to start at the same time. I usually discuss this with my collaborating radiation oncology physician. I usually like to time the radiation on D1 for logistical reasons. RT treatments for stage 3 disease ...
For patients who received neoadjuvant Imatinib for initially unresectable GIST tumours, do you routinely prescribe adjuvant therapy or rely on preoperative staging and preoperative mitotic index?
I agree with Dr Groisberg. Another way to look at it is that if the patient would have qualified by preoperative risk factors, I wouldn’t “downgrade” that by the improved risk tumor that comes out. Sometimes you can’t be sure ahead of time- for example I just saw a patient with a 3 cm duodenal tumor...
If you are treating a patient with palliative radiation for hemoptysis do you require chemotherapy to be held?
This is an interesting question. I would like to thank @Dr. First Last for his help with this. In recent years, I have rarely found myself asking colleagues from Medical Oncology to hold chemotherapy for patients who require palliative radiotherapy for hemoptysis. That being said, very few such pati...