Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How do you manage a nodal recurrence of an early stage glottic laryngeal cancer previously treated with definitive radiotherapy?
As a general rule, patients with post-RT recurrences that are resectable should undergo surgery rather than re-irradiation, unless surgery is expected to be associated with substantial risk or functional deficit (in which case the patient should be consulted about the risks of each modality). In the...
How do you counsel eligible patients on lung cancer screening who are hesitant because of the cancer risk from CT scans?
This is simple. The risk of lung cancer in patients who have smoked for >20 years is orders of magnitude higher than the theoretical risk of medical X-ray-induced cancers from low-dose CT (LDCT) screening. A typical LDCT scan exposes patients to approximately 1.5 mSv of radiation, equivalent to abou...
In a patient with pancreatic carcinoid s/p resection with positive margins do you recommend surveillance or adjuvant therapy?
Well-diff and by small size (<1 cm), NCCN guidelines would have said watch this from the start, so certainly wouldn't recommend any adjuvant therapy at this time for positive margin resection. Margin status has been shown not to be associated with overall survival outcomes, particularly for low-grad...
What do you view as the optimal use and timing of cemiplimab in high risk CSCC?
Increasingly, neoadjuvant cemiplimab has become our preferred approach for many patients with resectable high-risk CSCC, and this is consistent with what several high-volume centers are now doing. The high pathologic response rates, durable recurrence-free survival in responders, and meaningful surg...
Do you recommend prostate RT for patients with metastatic (M1) disease?
My short answer to this provocative question is “no, I don’t offer men with M1 disease local radiation unless there’s a palliative need.” Treating the primary in the asymptomatic M1 scenario, whether with RT or with surgery, is a major commitment of time, resources, and risk to the patient. The leve...
What are your top takeaways in Hematologic Malignancies from ASH 2025?
The PARADIGM study is a very important one that may result in a paradigm change for the treatment of AML. The study showed that outcomes are equal or better with AZA + VEN among patients with AML suitable for intensive chemotherapy. The efficacy was superior in response rate and EFS (but not overall...
What are your top takeaways in Hematologic Malignancies from ASH 2025?
The PARADIGM study is a very important one that may result in a paradigm change for the treatment of AML. The study showed that outcomes are equal or better with AZA + VEN among patients with AML suitable for intensive chemotherapy. The efficacy was superior in response rate and EFS (but not overall...
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...
Is it acceptable to give weekly cisplatin for patients with locally advanced head and neck SCC undergoing chemoradiation?
@Dr. First Last just presented at the ASCO H&N highlights session that weekly cisplatin 40mg/m2 is now considered a standard of care, at least in the post-op high risk setting based on data by Dr. Kiyota et al. showing superior outcomes, likely due to higher cumulative cisplatin dose (>200mg/m2) com...
How would you treat a young man with a history of stage IA testicular pure seminoma s/p radical orchiectomy who has a solitary left inguinal lymph node recurrence and normal tumor markers?
Relapse in an inguinal node is somewhat unusual in testicular cancer unless there has been prior scrotal violation or surgery for maldescent. Trans-scrotal biopsy of the testis is usually an incorrect approach, as it can cause a different pattern of spread (to the inguinal nodes). Thus, I would not ...