Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Given the results from the BILCAP trial presented at ASCO, would you change to or initiate therapy with capecitabine for patients with biliary tract cancer in the post-operative setting?
The BILCAP study represents the first data from a large, randomized, prospective, adequately-powered trial demonstrating a survival benefit for adjuvant therapy in this difficult-to-treat and relatively rare cancer.Given that capecitabine is relatively well tolerated, I would likely change from gemc...
Following long-term efficacy and safety data from the beti-cel trials, how do you approach gene therapy for eligible patients with transfusion-dependent β-thalassemia?
The results with beti-cel are excellent. So are the results with exa-cel. These two gene therapies use different approaches to modifying hemoglobin production in erythroid stem cells. Beti-cel adds a modified hemoglobin that resembles fetal hemoglobin using viral-mediated transduction, whereas exa-c...
Following long-term efficacy and safety data from the beti-cel trials, how do you approach gene therapy for eligible patients with transfusion-dependent β-thalassemia?
The results with beti-cel are excellent. So are the results with exa-cel. These two gene therapies use different approaches to modifying hemoglobin production in erythroid stem cells. Beti-cel adds a modified hemoglobin that resembles fetal hemoglobin using viral-mediated transduction, whereas exa-c...
Would you offer neoadjuvant radiation therapy with concurrent chemotherapy for a T4 rectal carcinoma with an associated rectovesical fistula?
In the past, some considered fistulas to be a contraindication for radiation therapy due to concerns about potential worsening. However, our understanding has evolved, particularly in cases where the tumor itself is often the primary cause or a significant contributor to the fistula. Consequently, i...
Does the presence of a KEAP1 mutation influence your decision to use adjuvant immunotherapy in stage II–III melanoma?
It is an interesting thought when you look at the mutations that may predict resistance to checkpoint inhibitors. However, I do not think we are at a stage where we can make a firm decision in the adjuvant setting (or any other setting) based on mutation profile. If there is a concomitant BRAF mutat...
How do you prioritize treatment in a lung cancer patient who has HER2 IHC3+ along with other actionable mutations that have tumor-specific drugs available?
Non-small cell lung cancer (NSCLC) can harbor different HER2 alterations: HER2 protein overexpression (2-35%), HER2 gene amplification (2-20%), and HER2 gene mutations (1-4%). Unlike breast or gastric cancer, HER2 protein overexpression in NSCLC is not a validated biomarker for first-line HER2-targe...
Would you consider testosterone replacement therapy in a symptomatic, hypogonadal man with a history of prostate cancer?
I would strongly consider TRT in men with a history of treated prostate cancer. If he has undetectable PSA 3 months post treatment, testosterone replacement is likely safe, does not increase risk of recurrence of cancer, will improve sexual symptoms, may improve cardiovascular risk factors, and musc...
How do you decide on treatment modality for ocular surface squamous neoplasia?
For primary OSSN, my initial treatment modality will either be wide surgical excision with cryotherapy and amniotic membrane graft or medical treatment with 5-Fluorouracil drops QID x7 days, followed by a 3-week drop holiday. I find that there is little to no downside to trying 5-FU first, given tha...
How do you approach patients with stage III unresectable, combined histology NSCLC/SCLC?
For stage III lung cancer with mixed NSCLC and small-cell lung cancer, we treat patients with concurrent chemotherapy (cisplatin/etoposide every three weeks) and definitive radiotherapy (60-66 Gy in 30 fractions, QD), followed by adjuvant immunotherapy (durvalumab). The rationales are as follows: Ra...
Which early-stage breast cancer patients who are candidates for 3-week hypofractionated whole breast EBRT are not good candidates for 1-week whole breast EBRT?
One important dosimetric criteria for 5.2 x 6 is V105 of 5% or less and v 107 of 2% or less. For 3-week RT, our data suggest v105 < 10% caused less morbidity. These dose homogeneity constraints are sometimes hard to meet for moderate or large size breasts, and one needs to be careful. Also, if a bo...