Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
What is your preferred choice of therapy for first-line treatment of a patient with good, intermediate, or poor risk stage III nonseminomatous germ cell tumor if the patient is truly cisplatin-ineligible?
The first question is what makes the patient "cisplatin-ineligible". Cisplatin has been given in patients on hemodialysis, guided by cisplatin levels and timing of dialysis. In someone with first-line intermediate and poor-risk disease, cisplatin is indispensable in my view.
What is your preferred mode of vascular access for testicular cancer regimens?
Actually, we try to avoid all vascular access devices, especially PORT, which causes a 10-20% risk for clot as well as infection. These are young healthy patients usually with excellent veins. Over 90% of our large patient populations with testis cancer simply get their 5 days of chemo with a restar...
How would you treat a T2N1 ER 90%, PR 10%, HER-2 negative breast cancer in premenopausal women with a tumor abutting the pectoralis fascia with loss of fat plane, with a concern for a positive surgical margin?
I would strongly consider neoadjuvant chemotherapy to improve resectability, assess treatment response, and reduce the risk of positive margins and extensive axillary surgery. Given the tumor’s proximity to the pectoralis fascia with loss of the fat plane, there is a real concern that upfront surger...
For patients with PI3K mutated metastatic breast cancer who progress on a PI3K inhibitor, will you use an alternative PI3K inhibitor subsequently?
Currently, there is no robust clinical evidence supporting the sequential use of different PI3K inhibitors after progression on a prior PI3K inhibitor. The INAVO120 trial (and CAPItello-291 for capivasertib) excluded patients who had prior treatment with any PI3K, AKT, or mTOR inhibitor, or any agen...
Is there specific data on using luspatercept for sickle beta+ thalassemia with transfusion-dependent anemia?
There is no data currently on the use of luspatercept in any condition other than beta thalassemia, including HbE-beta thalassemia. It has been studied in the beta thalassemia phenotype, both transfusion-dependent and non-transfusion-dependent (adult data published, pediatric trial underway), but no...
What is the preferred steroid regimen for metastatic prostate cancer patients on docetaxel?
TAX 327 (Tannock Et al NEJM 2004) used prednisone 5 mg bid in all patients (Q3 week Docetaxel and weekly Docetaxel). In addition, patients received dexamethasone 8 mg 3 times (12, 3, and 1 hour) before infusion. The prior phase 2 studies did not include prednisone with Docetaxel. Historically, low-d...
Do you hold or dose modify chemotherapy with BEP or EP for severe cytopenia or renal injury when treating testicular cancer in the curative setting?
No. In terms of cytopenias on day 22, it is usually granulocytopenia that concerns treaters. I look at the CBC and you will usually see a left shift c/w rapid recovery. If one is very concerned, you can add a granulocyte stimulating factor for this cycle. In terms of renal function, I would again ...
Does 4G/5G polymorphism in the plasminogen activator inhibitor (PAI-1) gene increase the risk of thrombosis?
Venous thromboembolism (VTE) is a classical example of a multifactorial disorder where genetic and environmental factors interact to result in VTE. Of the genetic disorders, in isolation, many are weak risk factors but when combined with other genetic or one or more environmental risk factors increa...
Does 4G/5G polymorphism in the plasminogen activator inhibitor (PAI-1) gene increase the risk of thrombosis?
Venous thromboembolism (VTE) is a classical example of a multifactorial disorder where genetic and environmental factors interact to result in VTE. Of the genetic disorders, in isolation, many are weak risk factors but when combined with other genetic or one or more environmental risk factors increa...
Would you discontinue or dose-reduce tamoxifen in a patient who developed hepatic steatosis?
In the absence of liver enzyme elevation and other risk factors for developing hepatic steatosis (such as obesity and dietary habits), I would be comfortable continuing tamoxifen. However, if tamoxifen-associated hepatic injury is suspected, my preference would be to discontinue tamoxifen or change ...