Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
What surveillance plan would you recommend for stage IV melanoma patients who achieve a CR or stable PR response with immunotherapy?
If melanoma patients have achieved CR or PR after a year of immunotherapy treatment, I highly recommend participation in this ongoing ECOG cooperative study: EA6192 / PET-Stop Educational Materials - ECOG-ACRIN Cancer Research Group (NCT04462406). The study uses PET scans in combination with contras...
How would you manage a patient with isolated metastatic high grade sarcoma to inguinal and external nodes in a patient with BRCA+ mutation?
Ovarian cancer treatments can work for BRCA2+ leiomyosarcoma.This has been published (Seligson et al., PMID 30541756) and I have had a couple of patients with BRCA2+ LMS. I had no luck with PARP inhibitors but one tremendous success with cisplatin, which produced a dramatic response in one heavily p...
What are the benefits and risks of using medical marijuana for cancer related symptoms?
The 2020 ASCO Antiemetic guidelines state that the evidence remains insufficient to recommend medical marijuana for either prevention or treatment of N/V in patients receiving chemotherapy or radiation therapy.There is insufficient evidence to recommend inhaled cannabis for cancer-related side effec...
What chemotherapy would you utilize for a metastatic dysgerminoma diagnosed in the second trimester of pregnancy?
Cisplatinum, Etoposide, Bleomycin
Can immunotherapy, alone or with chemo, be considered for ROS1+ NSCLC after exhausting ROS1 targeted therapy options?
Following evidence in more common driving mutations (especially those not associated with a history of tobacco use), I would not recommend immunotherapy alone for this group. When using chemotherapy, it is reasonable to consider adding immunotherapy, but there is no strong evidence to support it.
How do you decide on first line treatment for a patient with metastatic colon cancer with dMMR, a HER2 mutation and no mutations in KRAS or BRAF?
Would you consider perioperative chemotherapy in an anastomotic recurrence of gastric cancer after partial gastrectomy who did not receive prior chemotherapy or radiation?
My practice is to treat this exactly like de novo locally advanced disease. This means that the patient needs to be carefully (re-)staged, including with PET/CT scan, possibly an EUS, and most importantly, a diagnostic laparoscopy. Recurrence at the anastomosis can certainly also be associated with ...
When using IO therapy for front line treatment of metastatic RCC, is there a role for cytoreductive nephrectomy?
The role and timing of debulking nephrectomy in mRCC has been evolving over the last several years. This is in part due to CARMENA, which in my opinion reinforced that patient selection is critical, and in part due to increased activity of systemic therapy. I think patients with limited IMDC risk fa...
With new data showing similar outcomes of mismatched unrelated donor and haploidentical related donor allogeneic transplants using post transplant cyclophosphamide, how does one decide which donor is optimal?
It is certainly an unresolved question, and the short answer is that either would be an acceptable option with post-transplant cyclophosphamide (and I have used both). All recipients of mismatched donor transplants should be tested for the presence of donor specific antibodies, and their presence co...
What is your preferred second line therapy for patients with metastatic large cell neuroendocrine carcinoma of the lung after progression on first line chemo-immunotherapy?
Let's start by backtracking to the original treatment recommendation. Since large cell neuroendocrine carcinomas (LCNEC) of the lung can harbor mutations in EGFR or BRAF or even ALK rearrangements, next generation sequencing is appropriate for patients with advanced disease.Assuming no targetable al...