Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How do you discuss harms of MGUS screening with other medical providers?
I understand the intent of the question, but - as always - real life is more complicated. I agree that the evidence for screening completely healthy patients for MGUS does not currently exist. But, for patients with unexplained pertinent lab/imaging findings or symptoms, it's not unreasonable. In th...
Would you offer lung SBRT in a patient with Pulmonary Langerhans Cell Histiocytosis (PLCH)?
Langerhans cell histiocytosis (LCH) is a clonal proliferation of Langerhans cells (dendritic cells), part of the mononuclear-phagocytic system. Some patients present with unifocal disease, often in bone. A variety of treatments are acceptable for unifocal disease, including radiation therapy. Very l...
Would you give adjuvant chemo for a mucinous stage II adenocarcinoma of the colon in the lack of other high-risk clinical pathological features?
The mucinous feature is reported to be a poor prognostic feature in colorectal cancer based on some retrospective series (e.g., Symonds and Vickery, PMID 177180, Green et al., PMID 8380140, Catalano et al., PMID 21531784, and Ott et al., PMID 29870979). However, there are some other studies suggesti...
What chemotherapeutic regimen would you prefer in patients with T1N0 triple-negative breast cancer, assuming no contraindications to taxanes and anthracyclines?
In the joint analysis of the ABC (Anthracyclines in early Breast Cancer) presented at ASCO 2016 there was a 30% relative increased risk of invasive recurrence for women with ER/PR-negative, node-negative disease when an anthracycline was omitted (HR 1.31). Further subset analyses by tumor size were ...
Which imaging modalities and schedule do you use to follow stage I-II follicular lymphoma that was treated with radiotherapy alone?
PET has been demonstrated to be more sensitive and specific in staging for FL as well as a strong independent predictor of outcome after treatment. Patients also have ~50% risk of developing recurrence outside the RT volume - and PET allows for whole-body imaging. PET is therefore the imaging modali...
How long would you continue chronic transfusion therapy for adult sickle cell patients who have had a stroke?
There is no high-level evidence to inform the decision of how long to continue chronic transfusion in this scenario. Decisions on whether to continue indefinitely are affected by multiple factors like the presence of RBC alloimmunization, whether the patient was on hydroxyurea at MTD or not at the t...
Do you repeat antiphospholipid antibody testing in a patient that previously met criteria for APLS?
I would repeat APL Ab testing if I am trying to risk stratify a patient in preparation for pregnancy or surgery, for example. In some cases (see a recently posted question about stopping anticoagulation in people with prior APLS history), I would also consider rechecking if I am thinking about disco...
Would you retry rituximab in steroid refractory warm autoimmune hemolytic anemia which responded to rituximab before?
Yes, I would utilize rituximab a second time for treatment of AIHA in light of a response during the first episode. The first response was not that durable in this case, and it would be anticipated the response after the second round of rituximab may not be even as durable as the first. As usual wit...
Does ASC4FIRST data justify the use of first-line asciminib for all newly diagnosed CML over other TKIs, considering that post-progression survival data is not yet mature?
Ideally, every patient gets the newest and greatest, but the elephant in the room is asciminib’s $145,000 per year cost compared to imatinib’s $600.
Does ASC4FIRST data justify the use of first-line asciminib for all newly diagnosed CML over other TKIs, considering that post-progression survival data is not yet mature?
Ideally, every patient gets the newest and greatest, but the elephant in the room is asciminib’s $145,000 per year cost compared to imatinib’s $600.