r/Oncology

Hi, I’m a 31 yr old female. I got told I have Ewing sarcoma about 3-4 months ago. I had a HUGE tumor on my kidney and 2 spots on my adrenal gland. I had my kidney and adrenal gland removed May 6th. I had a spot on my lung before my surgery and stuff. But the spot is still there and grew just slightly. It did light up on the PET scan but nowhere else did. My margins were clean when they did the surgery also. My lung spot is 8mm. I went to sarcoma specialist and he wants me to start chemo (IE/VDC) this coming Thursday. Every 2 weeks, 14 sessions. I have to stay at the hospital minimum of 3 days up to 5 each time I get the chemo. I am BEYOND terrified of the symptoms I’ll have/get and if this cancer will ever go away. Mine is extraskeletal, so not in bones. I’m also getting a port put in and nervous about that too bc I’ve had 2 blood clots(provoked) after childbirth and I heard ports can cause clots.. I need some support with all this.

I’m a fellowship program manager for three ACGME fellowship programs (Hematology/Oncology, Endocrinology, and Hospice & Palliative Care), and I want to make sure our fellows have the best experience possible.

For current or former fellows: What did your program coordinator do that you found most helpful? Or what do you wish they had done to better support you?

I’m especially interested in ideas beyond the basic administrative responsibilities, whether it’s communication, wellness, scheduling, onboarding, educational support, or even the small things that made fellowship a little easier.

I’d really appreciate any suggestions. Thanks! ☺️

I’ve been a medical technologist for 16 years, specifically in flow cytometry for 13. I love it which is why I’ve been working in it for so long. I’ve even gotten my specialist license, but I feel that’s ignored because they would rather have a tech who doesn’t ever question them.

In the past few months, I feel they have missed major clones and it honestly breaks my heart. Recently we diagnosed an acute myeloid, but the abnormal blasts were present in the PB in low numbers two months ago. It was noticeable to me because it was CD34+CD4, but it was signed out as a normal. That was in April and in June, the patient came in through the ER with fully symptomatic acute leukemia.

Would a heme onc have done marrow or reflexed molecular back in April if that abnormality had been remarked on? Would it have made a difference in treatment? The clone is within our lower limit of detection, but I don’t know if it’s a certain percent of abnormal cells that would trigger further evaluation?

I can’t help but think about it and feel so guilty, but I also feel I don’t have the kind of professional relationship with the hemepaths where I can say something

thanks for reading

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My father (66M) was diagnosed with metastatic hormone-sensitive prostate cancer 2 months ago and we’re stuck in a situation where every oncologist we consult gives a different opinion on chemotherapy. Looking for real experiences from patients or caregivers who faced this same decision.

His diagnosis:
Gleason 4+5 = 9 (Grade Group 5), de novo presentation (metastatic at first diagnosis)

PSA at diagnosis: 251

PSMA PET-CT: PSMA avid left common iliac and external iliac lymph nodes. PSMA avid sclerotic and marrow-based lesions involving lower lumbar vertebrae, sacrum, and left iliac bone.
No visceral involvement (lungs, liver, brain all clear)

By CHAARTED criteria — this is LOW VOLUME disease (3 bone lesions, no visceral mets)

Current treatment (started June 2026):
ADT(degarelix) + ARPI(abirateron)

4 doctors have said no chemo required in Low Volume cases, 3 Doctors are very keen on chemo saying to strike hard as early as possible

In a huge dilemma of whether to proceed with chemo or not. Please guide!

My oncologist saved my life. What can I do to honor them? A thank-you note is a pitifully small gesture.

UPDATE: thank you everyone for your time, thought, and guidance. I'll start here.

His name is Dr. Gary Gordon. He's part of Northwest Haematology and Oncology in Elk Grove Village, Illinois. He fights cancer like Bruce Lee, deft and fierce, yet maintains his humility. Deepest respect. 100/10 stars recommend.

I'll give you the bullets and, if this is interesting, you can get into the deep dive below.

Bullets...

• Alpha Darts have been tested in conjunction with Keytruda (Pembrolizumab)
• What? Keytruda is Merck's $32B/year immunotherapy drug.
• When? Results will be announced on Tuesday, July 21st, 2026 at the AHNS cancer conference in Boston
• Who cares? Every oncologist, every solid tumor cancer patient and every DRTS investor
• Why? We may see the first fully documented Abscopal Effect
• What's that? Abscopal Effect is where treating one tumor causes tumors throughout the body to shrink - even though they were never directly treated.
• How? Keytruda can't "see" cold tumors. Cold tumors are its achilles heel. Once Alpha DaRTs "light them up" the tumor turns hot and Keytruda allows your immune system to destroy tumors all over the body.
• Which? All solid tumors.
• All? Yes. Skin, Breast, Lung, Colorectal, Pancreas, Prostate, Ovarian, Cervical, Head, Oral, Liver, Bladder, Vulvar, etc.
• Wait... Which doesn't it treat? The liquid cancers: Leukemia, Lymphoma, Multiple Myeloma
• OMG! I know, right?

Deep dive due diligence

Still here? Ok. Stay with me because what you'll read below might make you very wealthy. At minimum, you'll be more interesting at parties.

First, what is Keytruda? Keytruda is an immunotherapy. It's a PD-1 inhibitor and it's on pace to be the best selling (revenue) drug of all time.

Your body has killer T-cells that have a receptor on their surface called PD-1. It's like an "off-switch" to prevent it from destroying everything in a healthy body. PD-L1 is a camouflage shield that cancer uses to "trick" the killer T-cells into passing by the cancer.

When a T-cell approaches a cancer cell to inspect it, the cancer cell pushes the shield (PD-L1) into the T-cell's off-switch (PD-1). By plugging into that receptor, the cancer cell slams the brakes and the T-cell goes to sleep and the cancer continues to grow undetected.

Keytruda is an antibody engineered to fit perfectly on the PD-1 receptor of the immune cell. When a patient receives Keytruda, the drug floods the system and physically caps the PD-1 receptors with the result that the cancer can no longer flip the off-switch. The body's immune system (T-cells) recognize the cancer as hostile and destroy it.

Sounds amazing! It is. But Keytruda has a weakness called "cold tumors."

For Keytruda to be effective, it has to have two things:

1. Killer T-cells must already be inside or surrounding the tumor

2. Those T-cells must be actively trying to fight the cancer but are suppressed (shut off) by the tumor's defense shield.

Cold tumors have no T-cells inside the microenvironment to begin with. Keytruda's job is to "cut the brakes" so that the killer T-Cells don't stop fighting. No T-cells to cut brakes, no reaction to cold tumors.

Alpha Darts can target cold tumors. Using CT and MRI, we (humans) can see the tumors. Both hot and cold tumors will show up and appear as physical, abnormal masses of tissue. You won't be able to tell if the tumor is hot or cold because you can't see if it's crawling with fighting T-cells (hot) or if it's been deserted by the immune system (cold.)

Via advanced imaging (Immuno-PET) a hot tumor will glow brightly because it's packed with T-cells. A cold tumor will remain dim because there are no T-cells for the tracker to stick to.

Identifying and targeting the cold tumor is the key to unlock...

T H E H O L Y G R A I L

A cold tumor is completely invisible to the immune system. There are no T-cells there so drugs like Keytruda are completely useless.

By inserting Alpha DaRT directly into a cold tumor, the localized high LET radiation physically shatters the cancer cells. This forced destruction acts like a giant biological flare gun. It forces the tumor to spill its hidden internal proteins (antigens) directly into the tissue microenvironment.

This "wakes up" the immune system and rushes killer T-cells to the site and effectively turns the cold tumors hot. Once those T-cells are trained on the newly exposed cancer "fingerprints", they can travel through the bloodstream to hunt down other metastatic tumors elsewhere in the body. Keytruda ensures they never hit the brakes.

This is called the Abscopal Effect and it is a major paradigm shift in oncology.

Alpha DaRT's superpower here is its ability to "light up" a cold tumor, creating the exact environment that Keytruda needs to step in, jam the immune brakes open and unleash a full-body abscopal effect.

Historical note: We've seen some evidence of abscopal effect with Alpha Tau in the past. If you remember, we saw an instance during the Pancreatic presentation.

Personal note: My concern with this upcoming event is that we're dealing with elderly head & neck cancer cases. Elderly people already have a diminished immunity system and the recurring head and neck won't help. This Abscopal Effect won't wipe out tumors systemically unless there are T-cells to do battle. And the truth is that this combination therapy wasn't designed to test for Abscopal Effect but there is good news: It was set up with Best Overall Response Rate (ORR) as its primary objective.

RESULTS SO FAR...

The amazing news is that it worked, at least in early efforts.

ORR means the total percentage of patients whose cancer meaningfully shrank or disappeared.

ORR for Keytruda: 19%

ORR for Keytruda + Alpha DaRT: 75% (!)

Complete Response (CR) means all target cancer lesions have completely disappeared.

Complete Response Rate for Keytruda: 5%

Complete Response Rate for Keytruda + Alpha DaRT: 37.5% (!!)

If these numbers hold up in the presentation, this is a massive performance improvement to the biggest selling immune drug on Earth.

How this could play out...

Remember, Alpha DaRTs are a device and not a drug. Sorry to keep stressing that but it's important. With a device, you run a 30-50 person safety/feasibility trial and then you run a 300 person efficacy "pivot" trial.

If you are safe (trial 1) and more effective than the standard of care (trial 2) you get a gold star on your forehead and the FDA calls you certified.

The challenge is that the FDA won't approve Alpha DaRT + Keytruda. That's not how the FDA works. What they'll do is clear the path for Alpha DaRT + Keytruda in head and neck cancers to be approved.

Then, Alpha DaRT + Keytruda in the next solid tumor and the next solid tumor and the next solid tumor.

And each time, Alpha DaRT + Keytruda will be looking not just for ORR and Complete Response rates but they'll be looking for Abscopal effects.

Which cancers tend to be "cold?"

These will be names you recognize from recent, impressive results:

PDAC Pancreatic cancer - This is the quintessential cold tumor. Up to 70% of the tumor mass isn't actually cancer cells, it's a dense, scarring physical wall (desmoplastic stroma) made of collagen and hyaluronic acid (needed AI for that one.)

Glioblastoma (aggressive brain cancer) - GBM populates an environment heavily dominated by immunosuppressive cells rather than T-Cells. Keytruda has struggled here.

Ovarian cancer - some go hot but most are in "cold deserts."

Prostate cancer - Low mutational burden so it looks like normal healthy tissue. Once it becomes resistant to hormone therapy (castration-resistant prostate cancer) it metastasizes to the bone and is incredibly difficult to treat.

Colorectal cancer - 95% of metastatic colorectal cancers are "Microstaellite-Stable (MSS), meaning they have few mutations and are entirely cold. Keytruda is great with the 5% hot tumors here.

Oncology researchers are desperate for bridging technologies like Alpha DaRT. If a local treatment can shatter the dense stromal walls of PanC or force a low-mutation prostate tumor to spill internal antigens, it will act as a mechanical override - forcing these highly fatal "cold fortresses" to turn hot.

COSTS...

Reimbursement: If you have a choice of reimbursing a drug you know (Keytruda) and an outpatient targeted radiation treatment like Alpha DaRT or you could reimburse for Car-T, TIL Therapy or TCR-T therapy plus a required hospital stay, as an insurance provider, you're going with Keytruda every day. Here's why.

Keytruda: $10k to $15k per dose (given every 3 to 6 weeks) A full year costs $150k to $185k.

CAR-T therapy: MFG cost: $375k Total cost (plus hospital) $1M

TIL Therapy: MFG cost: $515k Total cost + hospital: $1M

TCR-T Therapy: MFG cost: $400k Total cost + hospital $1M

The reason these therapies are expensive is because scientists must physically harvest your cells, ship them to a multi-million dollar lab, re-engineer or cultivate them over several weeks and ship them back. This is a one-patient, one batch process. Then, patients must undergo intense chemotherapy to clear out their existing immune system to make room for the new engineered cells. The therapies can trigger life-threatening immune overreactions and patients routinely require days or weeks in ICU to manage the dangerous side effects while the cells adapt.

Compare that to popping a pill and undergoing a biopsy like outpatient procedure.

Not only the insurance guy but the oncologist and the patient will all want Keytruda + DaRTs.

CLOSING...

Still reading? Thank you for allowing me to share a double Ted talk. The abscopal effect, if it shows up consistently in conjunction with Keytruda means that we've won a battle. Oncologists have a new weapon, patients have new hope, and we have invested in a multi-billion dollar global platform across all solid tumors and we were there back when it was at a paltry $1B market cap back in mid-2026.

The drs did not like that I asked questions and had concerns. I guess they are used to people who come in and say ok do whatever and I have no questions! There is only one treatment protocol for me and that’s surgery, chemo, radiation, and hormone blocker for 5 years, more than likely it will come back. And I’m a stage 2 or 3. I saw the surgeon today which , she doesn’t have a sense of humor.😫 and she said chemo first then surgery, then left quickly bc she couldn’t answer my questions, and got the medical oncologist. The doctor answered some questions but she told me if I cannot tolerate the treatment plans then there is nothing she can do for me. A little background of me, 9 years ago o was given Otezla for psoriasis and psoriatic arthritis, that medication destroyed my biology and caused symptoms of severe side panic attacks and anxiety. Never had before. That lasted 8 months, and I had to learn to be confident in medication again. The dr did not want to believe that sometimes when I take a new medication it can cause a panic attack. She tried telling me it’s in my head and anxiety. To me I’m like after everything I’ve been going through the past few weeks I would have been having multiple panic attacks, but I’m not and my anxiety isn’t too bad either except before an appointment. Please tell me that all drs are not like this? I am trying to find humor behind all of this and stay positive, but I get looked at with disgust from the drs. I’m so lost and feel worse than I did finding out I have breast cancer . I am double negative carcinoma and in lymph node’s. I’m so dense they cannot even tell me a for sure stage until I get the mri of the breast. I need reassurance and support the most. Talking about my son’s graduation in 4 years, made me cry bc from what the dr is saying I could be dead by then.

To my nurses who work in oncology with pediatric; do you love your job? I always hear people saying it’s so depressing working with children who have cancer but it’s also gotta feel like a million bucks for the ones that do get better and knowing you were there helping them. I feel like you’d definitely need to balance your life in a healthy way outside of work. Any advice or experiences from the nurses who work this field would be appreciated!!!

I have a family member who was diagnosed with stage 4 pancreatic cancer in February. The cancer had metastasized into both the spleen and liver. He has been through 4 chemo treatments so far and had a scan this past week to check on the progress. His body is reacting well to the treatments so far. The spots on the spleen are completely gone, the liver ones have stayed the same/maybe even shrunk a little, and the pancreatic tumor has not grown at all. However, it’s hard to tell since they don’t usually see how the tumor is responding until after 5 or 6 chemo treatments so it’s still early. If the chemo stops working correctly then the doctor approved him for the daraxonrasid trial treatment pill. I read that this treatment option along with the previous chemo treatments can shrink or even get rid of the liver spots and even the tumor on the pancreas. Does anyone know if it’s possible for the liver spots to disappear from chemo alone and/or the daraxonrasid? I’d love to hear personal stories through this process. I’m trying to remain positive that remission is possible since his body seems to be responding well to treatment so far but it has been an extremely difficult process.

Is it worth it? I'm an oncology resident from brazil and i miss studying with question. Do you know how much is it and how can i get then? I found that there was very few information about it on the website

I am really just curious which cancer outcomes have improved in the last 10 or 20 years? For instance, stage 3 or 4 cancer. Treated or untreated. Does the treatment actually work? Are there any studies to show this?

Can anyone share their pet scan SUV 6 months post treatment? If you had something left behind that was likely inflammation when did they schedule your next pet?

I'm attending this virtual seminar and hope this link is useful for you!

I was diagnosed with this back in January of this year. It’s quite rare and my ocular oncologist was not familiar with it, I have yet to meet with a general Oncologist so I’m not sure how much they will know about it, either.

Something I’ve been curious about is what the consensus is on prescribing patients with this mutation GLP-1 medications, whether it be for diabetes or weight loss. I’m not asking if anyone here thinks it’s a good or bad idea if I use these medications, I plan to discuss that with my Oncologist when I meet her next month, but obviously there isn’t much discussion to find about this (or I at least haven’t had a lot of luck finding discussions/research about this.)