Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Is there any role for prophylactic DMARD therapy to prevent immune-related adverse events (irAEs) in patients receiving immune checkpoint inhibitors?
Excellent and timely question!There are no good studies-- but I truly believe this is where we are heading for cellular therapies and IO. I am unsure if it will be DMARDs, as lung cancer patients get premetrexed with IO and still develop irAEs-- it will more likely be bDMARDs.The reason, I believe, ...
What would be your radiotherapy plan for an overall stage IIA, low-lying, MMRd rectal adenocarcinoma to try to avoid APR?
For an MMRd rectal cancer, I would use immunotherapy! Very promising data from MSKCC suggesting upwards of 100% clinical complete response with dostarlimab alone, without the need for RT!
Is there a role for stents for patients with a new diagnosis of metastatic upper rectal cancer with a near-obstructing primary?
I haven’t had much luck with stents - they hurt, they often migrate, and tumor growth or perforation is also a risk. My preferred approach is a diverting colostomy, then total neoadjuvant therapy, then resection with eventual ostomy takedown. (This assumes curative intent disease.) Of course, this d...
How would you sequence/prioritize therapy for a patient with newly diagnosed large but relatively asymptomatic, limited small cell lung carcinoma of the lung with newly diagnosed partially obstructing ascending colon cancer with multiple large liver metastases confirmed to be of colon origin?
When two synchronous malignancies demand immediate intervention, a patient-tailored approach with overlapping regimens may be considered (Choudhary et al., ASCO 2025); however, in this particular case, sequential treatment is more appropriate given the asymptomatic nature of the colon cancer. There ...
How would you treat newly diagnosed good risk stage III seminoma with hearing loss?
In order to treat a newly diagnosed stage 3 seminoma in a hearing-impaired patient, my first step is to have the pathology confirmed by an expert GU-tumor pathologist to ensure that this is not actually NSGCT nor large cell lymphoma. While that is in process, I ensure that baseline tumor markers hav...
How would you treat metastatic colon cancer in patients on dialysis?
Fortunately, our standard regimen of 5FU and oxaliplatin are quite safe to administer for patients with chronic renal insufficiency/on dialysis: - 5FU is cleared through non-renal mechanisms and does not require any dose adjustments - BUT...exposure to capecitabine is higher in patients with renal i...
When (if ever) would you offer adjuvant sunitinib to a patient with chromophobe renal cell carcinoma?
To date, evidence is lacking to recommend adjuvant TKIs in chromophobe and other non-clear cell RCCs. The subgroup analysis in ASSURE trial (Lancet Oncology 2016, EA E2805) did not show any benefit of adjuvant sunitinib or sorafenib in nonclear cell RCCs (including 111 patients with chromophobe RCCs...
When consolidating DLBCL with radiotherapy, do you treat all originally involved sites, or just initially bulky and partial responder sites?
When consolidating DLBCL with radiotherapy, several parameters must be taken into consideration. a) Is radiation therapy part of the treatment plan "on top" of full systemic treatment because of a certain risk situation due to not-optimal response of disease to systemic treatment (for example, FDG-a...
Is enteric-coated aspirin acceptable to use in polycythemia vera or ET?
Admittedly, this is a question I had not considered before viewing this query, as I rarely, if ever, prescribe enteric-coated aspirin. In the absence of a bleeding diathesis such as von Willebrand disease, platelet count greater than one million/mm³, or active GI bleeding, low-dose aspirin (75/81/10...
Is enteric-coated aspirin acceptable to use in polycythemia vera or ET?
Admittedly, this is a question I had not considered before viewing this query, as I rarely, if ever, prescribe enteric-coated aspirin. In the absence of a bleeding diathesis such as von Willebrand disease, platelet count greater than one million/mm³, or active GI bleeding, low-dose aspirin (75/81/10...