Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
What treatment would you recommend for a patient with early-stage TNBC treated per KEYNOTE-522, PD-L1 CPS >10, with metastatic recurrence within 12 months of treatment completion?
In the absence of a clinical trial option for this patient with triple-negative breast cancer (TNBC) who had completed the KEYNOTE-522 regimen <12 months ago for non-metastatic TNBC and who now has metastatic TNBC which tested PD-L1 positive (PD-L1 CPS >10), I would offer immunotherapy with pembroli...
In a patient with a mid-esophageal squamous cell carcinoma with tracheal invasion confirmed on bronchoscopy, would you treat with definitive chemo-radiation with curative intent?
I generally start with chemotherapy alone in these patients, usually carbo/taxol for 2-3 months, and then re-evaluate with PET, bronchoscopy, and endoscopy to determine if there is still evidence of transmural invasion into the trachea. Often, if the tumor responds, the tracheal invasion is no longe...
How do you approach the treatment of LS-SCLC after SBRT for a prior NSCLC in the ipsilateral lung?
You know, it was so rare to see this in the first half of my career, and now I see it a few times a year. It's a testament to the improvements we are seeing in the care of lung cancer patients... they are getting 2nd cancers. Where I am (Mayo), we generally treat it exactly like an SCLC from the per...
Is there a role for quad-shot or similar regimen in a patient with a technically resectable, but medically inoperable colon cancer that is both bleeding and causing a partial obstruction?
I do not use quad shot for the palliation of gastrointestinal tumors. I do not believe in giving doses larger than 3 Gy per fraction because it uses up tolerance, and it's difficult to retreat. My strategy is to be able to treat the patient again after recovery of tolerance in a year. This usually r...
Should our selection for neoadjuvant chemotherapy in ovarian cancer patients change in light of COVID-19?
I see this as a two-pronged question where the response may vary based on the specific clinical situation, circumstances of the hospital, and status of the epidemic locally and regionally, along with available resources associated with the rapidly evolving COVID-19 pandemic. There is no question pri...
What are your top takeaways in Myeloma from ASH 2025?
As is probably true for most multiple myeloma-focused investigators, my interest was most piqued by the results of the MajesTEC-3 trial, which demonstrated an 83% 3-year progression-free survival in a population of patients with relapsed or refractory disease resulting from teclistamab and daratumum...
How do you decide when to pursue malignancy workup for patients with cryptogenic stroke?
Agree with above. I would also pursue malignancy work-up in this scenario as well: currently on anticoagulation (whether for afib or another medical reason) and has an ischemic stroke on top of that.
How do you decide when to pursue malignancy workup for patients with cryptogenic stroke?
Agree with above. I would also pursue malignancy work-up in this scenario as well: currently on anticoagulation (whether for afib or another medical reason) and has an ischemic stroke on top of that.
How would the updated results of ECOG 3311 influence your adjuvant RT recommendations for HPV+ OPSCC?
This question refers to this manuscript (Burtness et al., PMID 40493877), which is a 4.5-year follow-up of ECOG E3311.The results broadly mirror those seen in previous reports. The most notable novel finding reported is that among patients with low-risk features (who did not get any adjuvant RT), th...
What is your preferred third-line therapy for metastatic colon cancer, RAS-WT, MSS, low TMB, with no targetable alterations?
My preferred treatment in this scenario is trifluridine-tipiracil plus bevacizumab. This is based on the favorable side-effect profile of this regimen (compared to alternatives) and the evidence from the SUNLIGHT trial, which showed that bevacizumab plus trifluridine-tipiracil was superior to triflu...