Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Do you offer enasidenib with azacitadine in AML with an IDH2 mutation for patients ineligible for intensive induction chemotherapy?
I typically do not give enasidenib with azacitidine upfront for patients with AML with IDH2 mutation and ineligible for intensive induction chemotherapy. Based on the results of the VIALE-A study (DiNardo et al, NEJM 2020), I usually give venetoclax with azacitidine to those patients. In addition to...
Do you offer enasidenib with azacitadine in AML with an IDH2 mutation for patients ineligible for intensive induction chemotherapy?
I typically do not give enasidenib with azacitidine upfront for patients with AML with IDH2 mutation and ineligible for intensive induction chemotherapy. Based on the results of the VIALE-A study (DiNardo et al, NEJM 2020), I usually give venetoclax with azacitidine to those patients. In addition to...
Is there a correlation with severity of rash as an adverse event and response rate with capivasertib?
While it is tempting to hope that patients with significant side effects on targeted therapies might be more likely to demonstrate an antitumor response to that treatment, and there is limited data to suggest a possible correlation between immune-related adverse events and response to immunotherapy,...
When, if ever, would you recommend risk reducing BSO in patients with moderate penetrance breast cancer germline mutations?
RAD51C, RAD51D, and BRIP1 are all associated with significant risks of ovarian cancer and are appropriate for consideration of prophylactic oophorectomy, albeit perhaps at a slightly later age than BRCA1 and BRCA2. ATM and PALB2 may be associated with ovarian cancer risks that are similar to that of...
What approaches can we take to initiate therapy and improve survival rates in patients with HLH?
At our institution, we have comprised a multidisciplinary team to help treat these patients. The team or "HLH task force" as we like to call ourselves is comprised of a clinical immunologist, rheumatologist, dermatologist, critical care physician, hepatologist, BMT attending/hematologist, infectious...
How are you approaching patient selection and timing of RNA-based NGS, in light of the approval of zenocutuzumab for NRG1 fusion–positive advanced cholangiocarcinoma?
My standard has been to do all DNA, RNA, and IHC through a single vendor. I test all newly diagnosed patients with cholangiocarcinoma. I always do tissue and liquid biopsy NGS. If tissue biopsy is not feasible because of sample quantity/quality, then another biopsy will be the way to go to obtain, e...
What is your approach to iron deficiency anemia after a negative EGD and colonoscopy?
If there is no sign of atrophic gastritis and repeated fecal tests for blood are negative, I’d look first for celiac disease. If all the celiac screening tests rule it out, then I might team up with a hematologist to look for rare birds like transferrin deficiency. I’d probably ease back on PPIs if ...
Would you add immunotherapy to FOLFOX if the patient is not a FLOT candidate for neoadjuvant gastric cancer, extrapolating data from the MATTERHORN study?
While it is always somewhat perilous to extrapolate from a proper study to lesser situations, this seems quite reasonable. It seems highly unlikely that the removal of Taxotere from a fluoropyrimidine-oxaliplatin-based regimen would render immunotherapy less effective in gastric cancer. In the MATTE...
How do you interpret recent large retrospective analyses comparing radical prostatectomy vs. radiation for prostate cancer?
There have been numerous comparisons of RT vs. RP from a variety of study teams with various conclusions, and it often seems like the principal conclusion of the study is best predicted by the subspecialty from which the authors originated (urology vs. radiation oncology). As the question partially ...
How would you approach a patient with HR+, HER2- metastatic breast cancer who is endocrine resistant, with bone marrow involvement and pancytopenia?
Symptomatic bone marrow involvement (bone marrow carcinomatosis) is extremely rare in metastatic breast cancer and carries very poor prognosis. It is often associated with microangiopathic hemolytic anemia and DIC. Anemia is the most common manifestation and WBC and platelet counts are often not tha...