Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How do you approach cisplatin dosing for locally advanced head and neck SCC in HPV-positive and HPV-negative patients?
Weekly cisplatin 40 mg/m² is not yet considered equivalent to high-dose cisplatin 100 mg/m² every three weeks, and high-dose cisplatin remains the preferred regimen for both HPV-positive and HPV-negative locally advanced head and neck squamous cell carcinoma. However, weekly cisplatin is an acceptab...
How do you approach systemic treatment for isolated CNS recurrence of ER+/HER2+ disease, with local treatment completed, with prior treatment with chemotherapy + anti-HER2 agents?
This is always a difficult scenario with no clear guidance, and I think depends on a good discussion with the patient. My preferred approach to this scenario is similar to an isolated CNS progression, in which we would not change systemic therapy if treated with local management. In this case, the p...
When treating rectal cancer with TNT and induction chemotherapy first, do you repeat pelvic MRI prior to planning for chemoradiation?
TNT approach options for pMMR T3, N any; T1–2, N1–2; T4, N any or locally unresectable or medically inoperable rectal cancer patients include:First chemotherapy for 12-16 weeks (FOLFOX or CAPEOX may also consider FOLFIRINOX) followed by long-course chemoradiation or short-course radiation, followed ...
How would you manage relapsed DLBCL in a patient who received second line CD19 CART treatment?
With commercial CD19 CAR-T therapy moving into earlier lines of therapy, post-CAR-T relapses are now more common. There are still many options depending on what first-line/bridging therapy was given, CD19/20/30 expression, and patient preferences. I always get a biopsy if feasible to confirm relapse...
How would you manage relapsed DLBCL in a patient who received second line CD19 CART treatment?
With commercial CD19 CAR-T therapy moving into earlier lines of therapy, post-CAR-T relapses are now more common. There are still many options depending on what first-line/bridging therapy was given, CD19/20/30 expression, and patient preferences. I always get a biopsy if feasible to confirm relapse...
In what cases of T3N0 glottic SCC, would you omit chemotherapy and offer radiation alone?
The question seems to stem from a presentation of a patient that would have historically been stage 2, but more recent editions of AJCC and more refined imaging have upstaged the patient to stage 3 by calling minimal paraglottic extension on an MRI. This is similar to a previous question where a pat...
When would you consider initial induction chemotherapy (e.g. FOLFOX) followed by neoadjuvant chemoradiation, over neoadjuvant chemoradiation alone, in patients with locally advanced rectal cancer?
At MSKCC, we now routinely recommend induction chemotherapy (8 cycles of FOLFOX) to any rectal cancer patient who requires preoperative chemoRT. Initially, we adopted this approach for patients with particularly bulky or node-positive disease (as per @Dr. First Last's answer above) but now do it for...
Do you recommend ovarian suppression in all premenopausal women under age 35 with ER positive breast cancer based on the SOFT/TEXT data, regardless of other risk features?
I do not recommend ovarian suppression on all women under 35. Like any intervention, we need to know the absolute risks of recurrence with and without the intervention. For these reasons, given the side effect profile of ovarian suppression in younger women, I usually reserve it for women with large...
Do you still recommend protons for grade 2 and grade 3 glioma, following the Soprano study results showing a survival detriment?
I should start by saying that I generally do not recommend proton therapy for grade 2-3 gliomas in adults unless there is a clear and specific indication. Modern photon techniques such as VMAT are highly conformal, efficient, and safe, and they form the backbone of the evidence base that guides our ...
Based on TAILORx, what will be your approach to a pre-menopausal woman with a recurrence score 16-25?
In TAILORx, women with intermediate recurrence scores (11-25) did not benefit from chemotherapy. However, an exploratory analysis suggested some chemotherapy benefit for women age less than 50 (compared to older than 50) with recurrence scores of 16 to 25. Therefore, many would suggest that premenop...