Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Would you give consolidation durvalumab to a patient who underwent chemoradiation for his stage III NSCLC and is being started on antifibrotic therapy by pulmonology for his ILD?
This is a difficult scenario. On the one hand, we know from the PACIFIC trial that there is a clear benefit to the addition of durvalumab in this setting. On the other hand, there is a higher risk of pneumonitis due to both the prior use of radiotherapy and the history of underlying ILD. I think ECO...
How does the extended PFS data (>4-year median) with taletrectinib impact your choice of frontline therapy and subsequent sequencing approach for ROS1+ NSCLC?
Overall favorable and is the preferred 1L option for newly diagnosed advanced ROS1+NSCLC, and also the preferred 2L option in my practice currently for those who were started on older approved agents such as crizotinib. Better balance between efficacy and toxicity profile compared to other available...
How would you treat an elderly patient with metastatic breast cancer with two new progressive right breast/chest wall lesions?
I addressed the question of how to manage patients with symptomatic breast masses in a posting on December 19, 2025. The first question for this patient with progressive lesions is whether they are symptomatic now or not. If not currently symptomatic, then I would likely defer RT until such time as ...
Do you consider MSI testing for mCRPC?
I agree that data for response to immunotherapy in MMR-deficient (dMMR) prostate cancer is limited, and we estimate the rate of dMMR in prostate cancer to be low, in the 2-3% range. Nonetheless, based on responses in other dMMR tumors, pembrolizumab is now FDA approved for all dMMR/MSI-high unresect...
What objective tools do you use to help determine if a patient is too high risk for anticoagulation to prevent stroke or DVT?
There are a number of risk scores, like HAS-BLED, that can be used, but I continue to use clinical judgment and shared decision-making. The excellent risk profile of NOACs and the availability of LAAO mean that I can usually come up with a solution for almost every patient that will protect them fro...
When (if ever) would you offer radiotherapy for renal cell carcinoma following nephrectomy?
There is no indication for any type of radiation after nephrectomy in resected RCC. Often a 'positive' renal vein margin is not a true positive, but rather an artifact of having a renal vein thrombus and this should be discuss with the Urologist and Pathologist and clarified in the report. Having sa...
Would you consider adding gabapentin off label for use in the treatment of glioblastoma at this time?
As an author on the paper, let me emphasize the findings and speculate on the implications. Recently, a number of laboratories have unraveled stunning preclinical and mechanistic findings demonstrating the ability of a subset of malignant glioma cells to usurp neuronal circuitry to promote tumor gro...
How to approach reversal of TNK in hemorrhagic conversion of ischemic stroke?
There is no specific "reversal agent" for tenecteplase. Once administered, the thrombolytic effect will persist until the drug is fully metabolized and any residual plasmin has been cleared by alpha-2-antiplasmin. So, perhaps the first question is what can you do if there is an acute bleeding event ...
Do you wait to treat small asymptomatic brain metastases until they reach a certain size?
I typically treat all lesions on MRI that are found to be concerning for brain metastases. This is after a discussion with our neuroradiologist colleagues. If there is uncertainty that a small lesion may not be a brain metastasis, then I will elect to follow with a surveillance MRI and treat in the ...
Should we be stopping new starts of patients who can be triaged for 2-3 months like prostate cancers on ADT when significant community spread of COVID-19 is detectable in our area?
I would for those patients requiring ADT, which is the way I interpreted the question. I want to elaborate more because @Dr. First Last brought up other scenarios we should consider and he brings some more good points: Many patients could get active surveillance for a period of time before ADT is co...