Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
What is your preferred frontline treatment for CLL in young patients < 50 years old?
For younger patients, just like older patients with CLL, my preference for frontline treatment is based on genomic characteristics, fitness, and patient preference. I also prefer clinical trials over standard therapy, when available. For those young fit patients with IGHV mutated disease, the option...
What is your preferred frontline treatment for CLL in young patients < 50 years old?
For younger patients, just like older patients with CLL, my preference for frontline treatment is based on genomic characteristics, fitness, and patient preference. I also prefer clinical trials over standard therapy, when available. For those young fit patients with IGHV mutated disease, the option...
When considering cytoreductive nephrectomy in metastatic kidney cancer, in which situations would you consider nephron-sparing approaches such as partial nephrectomy or SBRT?
Nephron-sparing strategies (partial nephrectomy or stereotactic radiation therapy are reserved for patients with limited disease, favorable anatomy, or contraindications to surgery, where the goal is to maximize oncologic control while preserving renal function and minimizing morbidity. Careful mult...
How do you manage the thickened secretions secondary to xerostomia during head and neck radiation?
I find that the management of acute effects of RT for H&N treatment is somewhat of a dark art. What works for one patient may not work for another. The thickened secretions are from acute irritation of the salivary glands and not so much from "xerostomia" during the acute phase of RT. For thickened ...
How would you treat an early-stage dMMR rectal squamous cell carcinoma in an otherwise healthy elderly patient?
With no squamous cells in the actual rectum, I typically treat this as I would anal cancer—definitive chemoradiotherapy, ideally with capecitabine/5-FU-mitomycin (Day 1 only).
How would you approach a T1N1 NSCLC with a small peripheral primary tumor and single hilar node in a patient not fit for concurrent chemo or surgery?
If the patient were not a candidate for surgery or chemotherapy, then I would favor hypofractionated radiotherapy to 60 Gy in 15 fractions to both the primary and the hilar lymph node based on UTSW phase I data. If the patient may be a candidate for immunotherapy, then I would strongly consider enro...
Under which circumstances would you prefer ropeginterferon over hydroxyurea for patients with Polycythemia Vera?
The approval of ropeginterferon (Besremi) for the treatment of polycythemia vera (PV) without any restrictions was a welcome event for PV patients and their physicians. First, because this drug selectively targets the JAK2-mutated hematopoietic stem cell (HSC) responsible for PV and can produce comp...
Under which circumstances would you prefer ropeginterferon over hydroxyurea for patients with Polycythemia Vera?
The approval of ropeginterferon (Besremi) for the treatment of polycythemia vera (PV) without any restrictions was a welcome event for PV patients and their physicians. First, because this drug selectively targets the JAK2-mutated hematopoietic stem cell (HSC) responsible for PV and can produce comp...
How should immunotherapy be incorporated into the treatment strategy for patients with resectable stage III microsatellite instability–high (MSI-H) or mismatch-repair-deficient (dMMR) extrahepatic cholangiocarcinoma?
Great question, and one that we do not have clear data to support, but could certainly extrapolate. KEYNOTE 158 trial included 22 patients with advanced cholangiocarcinoma, and response was 40.9% with a median duration of response not reached (mOS 24.3 months; 6.5-NR) (Marabelle et al., PMID 3168255...
How would you treat a patient with POEMS syndrome with severe debilitating neuropathy?
This is an important question. Peripheral neuropathy is one of the mandatory criteria for a diagnosis of POEMS syndrome, and can range from mild paresthesias to devastating, wheelchair-bound neuropathy (Dispenzieri, PMID 37732822). What makes POEMS uniquely gratifying is that effective therapy can l...