Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How do PSMA PET positive nodes change your treatment recommendations after RP?
I would incorporate PSMA avid regional node findings into salvage treatment planning with regard to guiding a) nodal basin coverage extending to give buffer on most cranial node or at least to the aortic bifurcation given PSMA-LND correlate studies often showing more involved adjacent basin disease ...
What treatment would you recommend in an older patient with multiply relapsed double-hit lymphoma with recurrence following ASCT, pola-BR, and CAR-T therapy?
Challenging scenario for sure. Clinical trial could be preferred here - studies in this space include bispecific antibodies, CDK9 inhibitors, and TCA inhibitors, among others. Standard-of-care wise, presuming that biopsy confirms retention of CD19 expression, there is a literature establishing activ...
What is the optimal management of patients with gastroesophageal cancer who progress to metastatic disease during preoperative FLOT?
As we all know, peri-operative FLOT is considered a standard-of-care for locally advanced GEJ/gastric adenocarcinomas (at least the vast majority of tumors that are MMR proficient/MSS). In my experience, actual progression of a carefully staged locally advanced cancer to metastatic disease during pr...
Would you give liposomal doxorubicin to a patient with recurrent left thigh atypical spindle cell lipomatous tumor, low to intermediate grade, that is not a surgical or radiation candidate?
No.
For patients who received neoadjuvant chemotherapy and found to have an EGFR sensitizing mutation at time of R0 surgical resection, would you offer still offer adjuvant osimertinib?
This question has several nuances to address with the rapidly evolving therapeutic landscape for early-stage lung cancer, specifically patients with EGFR mutation. First is the question of neoadjuvant therapy and whether genomic testing should be done prior to offering neoadjuvant treatment. With th...
Do you routinely use mannitol to prevent cisplatin-induced nephrotoxicity?
Having treated thousands of patients over the past several decades, we NEVER use mannitol nor do we find any logic for its administration in patients getting appropriate pre-chemo and post cisplatin saline hydration.
How would you approach therapy for newly diagnosed germinal-center DLBCL who previously received an unknown systemic regimen with radiation for history of Hodgkin Lymphoma?
A lot of times, you can ask the patient if they received a red medication (doxorubicin) or if their hair fell out to determine prior anthracycline exposure. If you cannot confirm, I would assume that they received ABVD x 6 cycles. This would be a cumulative drug exposure of 300 mg/m^2. Depending on ...
For a patient with metastatic gastric adenocarcinoma with CT showing NED after 4 months of FOLFOX + pembrolizumab + trastuzumab, would you consider resection of the primary and/or a chemo break?
This question is about a patient with gastric cancer who has a complete response to therapy with chemotherapy, trastuzumab, and checkpoint inhibitor blockade. The patient had a radiographic CR after 4 months of therapy. How to proceed from here is an interesting question, and would be influenced by ...
How would you approach a patient with well controlled metastatic lung cancer who develops a new primary P16 positive oropharyngeal squamous cell carcinoma?
Multiple primaries are not uncommon. Given tremendous advances in treatments of advanced lung cancer and consequent improvement in overall survival, it is important to focus on screening, early detection, and curative-intent of other cancers whenever applicable. This seems to be one such situation. ...
Would you consider de-escalating abiraterone in a patient treated with ADT/abiraterone/prednisone for metastatic hormone sensitive prostate cancer who has had an excellent response with undetectable PSA and minimal side effects for over 2 years?
Wonderful question. There really is no data to guide this question. Some people are wondering about de-escalation of therapy from the start vs super escalation (triple therapy) for other patients. This strategy makes biologic sense. Match the therapy to the biology of the cancer. The challenge is th...