Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
In patients with unresectable, liver-limited neuroendocrine tumors (NETs), what clinical or radiographic criteria guide your decision to prioritize systemic therapy over locoregional approaches?
The first question is always if it is truly unresectable... What is considered unresectable by some might be considered resectable by others, so I always recommend getting an opinion from an HPB surgeon with substantial experience in treating patients with NETs (whether that is done in person or at ...
How do you manage oxaliplatin-induced splenomegaly?
Oxaliplatin can lead to sinusoidal obstructive syndrome (SOS), which will result in portal hypertension. Splenomegaly is one of the portal hypertension signs.The SOS is correlated with cumulative oxaliplatin dose, and cumulative dose >1000 mg/m2 is considered a potential threshold (Overman et al., P...
Is there a scenario in which you would consider observation for T4a SCC involving the mandible?
While PORT is well established, the scientific basis for it is relatively weak in the absence of a randomized trial, as all phase 3 trials have focused on adding something to radiation rather than the benefit of radiation alone. Further, the rationale for PORT historically is if there is a belief of...
What are your top takeaways from ASCO GI 2025?
1. BREAKWATER: Analysis of first-line encorafenib + cetuximab + chemotherapy in BRAF V600E-mutant metastatic colorectal cancer. This ambitious phase 3 randomized trial is an initiative of project frontrunner to attempt to allow access of targeted therapy in earlier lines of treatment for advanced ca...
In a patient with metastatic colorectal cancer to the lung and liver, is there a role for liver directed therapy if the lung is not amenable to local therapy?
This is a heterogeneous group of patients, so I don’t think there is one answer applicable to all clinical situations. This is why it is so important that these patients be discussed in a multidisciplinary setting. I’m assuming that in this situation the patient has had adequate systemic therapy to ...
Would you offer postoperative RT for pT2pN0 rectal cancer with close distal margin (within 2 mm) and only 6 lymph nodes obtained from surgery?
I assume the question is about the addition of chemoradiation in this setting. In this case, there is one clear reason to consider post op chemoradiation - the 6 LNs removed. This is clearly short of the standard for adequate lymphadenectomy of 12. It may be possible to ask the pathologist to review...
Are there any molecular predictors for response to chemoimmunotherapy for patients with ES-SCLC?
The short answer is no, there are no validated, clinically useful biomarkers to predict benefit (or lack of benefit) with immune checkpoint inhibitors for patients with SCLC.Early studies, including KEYNOTE-028 and KEYNOTE-158, suggested that PD-L1 TPS (tumor proportional score) correlated with resp...
How do you incorporate radiation therapy in patients undergoing CAR T-cell therapy for DLBCL?
It depends on the circumstances of the patient, but there are three emerging indications for RT in the setting of CAR T-cell therapy: Tumor debulking prior to CAR T-cell infusion Bridging therapy between apheresis and CAR T-cell infusion Salvage of refractory, progressive or relapsed disease follow...
Would you give adjuvant TDM-1 to a patient with HER2-positive breast cancer s/p NAC with TCHP found to have no residual disease in the breast, but presence of ITCs ypN0(i+) in one axillary lymph node?
Adjuvant T-DM1 is not recommended for a patient with HER2-positive breast cancer who has no residual invasive disease following neoadjuvant chemotherapy (NAC) and only ypN0(i+) findings. In this setting, the patient is considered to have achieved a pathologic complete response (pCR), and adjuvant tr...
Which patients are you utilizing subcutaneous PD-1/L1 inhibitors instead of the intravenous formulation?
The only one of these agents I use in my Breast Oncology practice is pembrolizumab. I would be comfortable substituting SC for IV pembrolizumab if covered by insurance, but I have not yet had an instance where I have tried this.