Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
In light of promising results of hydroxychloroquine in COVID-19, should we consider using it prophylactically in cancer patients, especially if immunocompromised?
At this time, as there is no good evidence available, I would not recommend the use of hydroxycholoroquine prophylactically in cancer patients. It is unclear whether it would prevent contagion, probably not, and we still don't know if it will have any effect on the course of COVID-19. We expect ther...
Is it acceptable to treat patients with limited, asymptomatic brain metastases and EGFR-mutant NSCLC with upfront TKI?
Though some clinicians have been exploring the idea of targeted therapy for EGFR mutant brain metastases, this has been done in the absence of strong evidence. Reasons for pushing this idea are that sometimes the lesions seem to respond, and this has been seen in some single arm studies and anecdota...
How would you approach a stage 1 HR+/HER2- pre-menopausal patient <50 years old with Oncotype DX RS of 24?
All the prior comments are very reasonable. It is hard to completely exclude a small absolute benefit from chemotherapy in this group. The trial's subset analyses aren't designed to definitively answer whether ovarian suppression or direct action of the chemo led to the observed risk reduction in <5...
When will you prescribe 3 v. 6 months of FOLFOX or XELOX for the adjuvant treatment of colon cancer?
This set of studies will do more to reduce toxicity for patients than any other studies presented at ASCO this year. Based on these results, I plan on treating stage III patients as follows: 1. For T4 and/or N2 patients, I will continue to recommend FOLFOX or CAPOX for 6 months, and continue to adju...
For patients with locally advanced rectal cancer who desire organ preservation and can tolerate fluoropyrimidine but not oxaliplatin, what is the appropriate treatment approach?
For patients with locally advanced rectal cancer who desire organ preservation and cannot tolerate oxaliplatin, the appropriate treatment approach would be neoadjuvant, long-course radiotherapy combined with fluoropyrimidine-based chemotherapy. After neoadjuvant treatment, patients are ev...
In light of GOG-252, are there any situations where IP chemotherapy would be preferable following debulking of advanced epithelial ovarian cancer?
In GOG-252, the control arm (arm 1) was the dose-dense Japanese GOG (JGOG) regimen, compared to two IP-based arms (arm 2, IP carboplatin, and arm 3, IP cisplatin). As stated in our OGR, interpretation of the negative results of this study is difficult for several reasons. All three arms in GOG-252 r...
How long do you treat with IMID in a case of smoldering multiple myeloma?
I have not yet adopted use of lenalidomide for SMM, as I believe in the future, we will do away with the definition of SMM—patients either have MGUS which is observed, versus MM which requires the standard platform of myeloma treatment. This will be accomplished with a better molecular understanding...
Do you consider the duration of lung/lobar atelectasis in your decision making while offering airway stents for malignant central airway obstruction?
Yes, always. We review old imaging to determine when there is a post obstructive pneumonia or collapsed lobe/lung secondary to endobronchial obstruction (extrinsic or intrinsic). The old teaching was that, if a lobe is down for more than two months, it is unlikely to be salvaged, even after the endo...
When do you recommend patients get vaccinations with respect to their RT course?
I agree with @Dr. First Last's reply, and find that some patients are under the impression they are immunocompromised during radiation therapy and thus should avoid vaccines, when in fact the opposite is true. The skepticism behind the science of vaccination also can lead to avoidance, and so I try ...
Would you offer neoadjuvant chemotherapy to premenopausal women with cT1cN0 HER2+ breast cancer?
Since most neo-adjuvant trials required that primary tumor was at least 2 cm, I tend to lean towards upfront surgery. If the tumor size is confirmed and sentinel lymph nodes are negative, the patient could be offered paclitaxel and trastuzumab which is significantly less toxic than pertuzumab in com...