Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Would you use consolidation immunotherapy after chemoradiation for patients with stage III NSCLC and EGFR amplification?
The short answer is yes, as long as there is no concurrent oncogenic EGFR mutation. During the early days of EGFR-TKI development over 20 years ago, there were different predictive biomarkers proposed and studied. Pitted against each other were biomarkers using more established pathology methods (EG...
In what situations would you treat a rectal mass as cancer despite negative biopsies?
It is not uncommon to see a patient with rectal mass highly suspicious for malignancy by endoscopic evaluation but has a negative biopsy. Usually, this is due to superficial biopsy specimens. In our clinic, we usually get repeated endoscopic evaluation with biopsy as our first step. However, a small...
How do you reconcile the differing outcomes of the MATTERHORN and KEYNOTE-585 trials when determining systemic treatment approach for gastric/GEJ adenocarcinoma?
As it turns out, the outcomes are much more similar than dissimilar. While we all know MATTERHORN was a clearly positive study, KEYNOTE-585 was essentially also a positive study, obscured by a negative overall interpretation and undermined by its complicated statistical design.Specifically, 804 pati...
Would you consider utilizing pembrolizumab/enfortumab as a bladder preservation approach in patients with MIBC?
Yes, I think that this is a viable approach. Data from perioperative trials, including KN-905 and EV-304, suggest very high rates of pathologic complete responses in almost two-thirds of all patients at the time of radical cystectomy. Many of these patients may not need radical cystectomy for an opt...
Do you utilize D-dimer to inform anticoagulation duration in the treatment of VTE?
I had developed a policy during my last eight or ten years of practice evaluating how long patients should be treated after a thrombosis and I'd like to share some impressions over these years as well as conclusions that I reached. These conclusions formed the basis of my approach to this problem. I...
Do you utilize D-dimer to inform anticoagulation duration in the treatment of VTE?
I had developed a policy during my last eight or ten years of practice evaluating how long patients should be treated after a thrombosis and I'd like to share some impressions over these years as well as conclusions that I reached. These conclusions formed the basis of my approach to this problem. I...
How do you manage sexual dysfunction in women receiving ovarian suppression for breast cancer?
Asking questions about sexual dysfunction during routine follow ups is important. Many women may feel uncomfortable bringing up the issue. Next important to evaluate contributors such as physical complaints of dryness, dyspareunia, or libido issues, body image concerns, or relationship concerns. Phy...
What duration androgen deprivation do you recommend with salvage pelvic radiotherapy for pelvic node relapse after prostatectomy?
6 months ADT, 2 years ADT, 2 years ADT + abiraterone/prednisone seems reasonable depending on the circumstances. For example, early pelvic node recurrence for pT3b Gleason 4+5 would be a higher risk than a very late recurrence of pT2 Gleason 3+3.
In a patient with de novo metastatic RCC s/p Ipi/Nivo with partial response and residual viable RCC on cytoreductive nephrectomy, would you add cabozantinib or other TKI prior to disease progression?
Cytoreductive nephrectomy in asymptomatic patients is a controversial topic. There is some data suggesting clinical benefit to patients, but prospective data in the present checkpoint inhibitor era are needed. Fortunately, there are ongoing prospective clinical trials to provide this much-needed dat...
What is your approach for perioperative chemotherapy in MSI-H/dMMR localized gastric cancer?
This question gets at aspects of MSI-H biology, biomarker testing and post-hoc data from the MAGIC and CLASSIC trials suggesting a lack of benefit, and potential negative impact of treatment in MSI-H patients. The following is restricted to gastric cancer, and the rates of MSI-H in true esophageal a...