Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
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.
How would you define your radiation treatment volume for a primary diffuse large B-cell lymphoma of the L4 vertebral body that had a complete response to chemotherapy?
For a primary DLBCL involving only the L4 vertebral body with a CR after chemotherapy, we would include just the involved L4 vertebral body. There is no need to include one vertebral body above and below. Effort should be made to reduce excess dose to the bowel and adjacent bone marrow with either a...
What treatment options would you consider for an anorectal adenocarcinoma following long course chemoRT, mFOLFIRINOX, and APR followed by an incomplete re-resection of a local recurrence?
A more comprehensive characterization of this case will be crucial. Critical information includes the initial disease presentation and stage, treatment timeline, tumor response to each therapeutic modality (radiation, chemoradiation, and systemic chemotherapy), results of preoperative imaging, surgi...
Would you treat rectal squamous cell carcinoma the same as rectal adenocarcinoma, stage for stage?
No, I will treat rectal squamous cell carcinoma the same as anal squamous cell carcinoma, with definitive chemoradiation with 5FU/mitomycin. If the cancer invades the posterior vaginal wall or prostate, I will also include external ilac nodes. If the tumor involves lower rectum/anus, I will also tre...
For a patient with IIIC1 (micromets), MSI-high, Grade 2 endometrial adenocarcinoma who has undergone full surgical staging, do you recommend adding immunotherapy to adjuvant chemotherapy + radiation?
Short answer: No, I do not recommend adjuvant CT/IO + RT for this patient based on the patient's risk factors in the prompt, and the data below. Should the patient have recurrent/metastatic disease following adjuvant CT + RT/VCBT, then I/O + CT is a good option. Ongoing trials hope to answer this qu...
For a patient with locally current endometrial cancer whose disease had complete radiographic response to carboplatin, Taxol, and pembrolizumab, would you consider adding radiation therapy?
Despite having a complete response to chemoimmunotherapy, I would tend toward adjuvant RT since this was a local recurrence. We don't have long-term data with chemoimmunotherapy in this locally recurrent setting.
How do you counsel an otherwise healthy patient on how soon they can go back to moderate exercise after a bilateral pulmonary embolism?
Generally, the approach is to have the patient start their exercise regimen at a lower intensity and gradually increase it based on their tolerance.
Would you use argatroban or citrate catheter lock in a patient with ESKD and HITT?
I would use 4% citrate. I have no experience using argatroban as a catheter lock solution, but have significant experience using 4% citrate solution. For our inpatients, we only use 4% citrate solution (and have done so for many years). While I believe you can buy prefilled 4% citrate syringes comme...