Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Would you expect a reduced neutrophil count in individuals with a partial duffy null phenotype?
The Duffy null phenotype's impact on neutrophil counts is "all or none". Approximately one-third of patients with the Duffy null phenotype Fy (a-b-) will have a neutrophil count below the usual lower limit of normal. The range of neutrophil counts in individuals with Fy (a+b-) and Fy (a-b+) is exact...
Do you consider NSCLC with multistation N2 involvement appropriate for treatment with neoadjuvant chemoimmunotherapy followed by surgery?
Interesting question and something that is frequently discussed in tumor boards. Multistation N2 patients were not included in neoadjuvant trials and hence, any adaptation of this strategy to patients with advanced N staging would not be appropriate at this time. Further, given level 1 evidence from...
How would you approach a stage 1 HR+/HER2- pre-menopausal patient <50 years old with Oncotype DX RS of 24?
All the prior comments are very reasonable. It is hard to completely exclude a small absolute benefit from chemotherapy in this group. The trial's subset analyses aren't designed to definitively answer whether ovarian suppression or direct action of the chemo led to the observed risk reduction in <5...
How would you determine the safety of anticoagulation in patients with evidence of cerebral microhemorrhages who present with acute stroke secondary to cardioembolism?
This question assumes that the patient already had an MRI showing microhemorrhages. The Boston criteria provide guidelines for the number of microbleeds, associated superficial siderosis, or major hemorrhage to make the diagnosis of cerebral amyloid angiopathy. I would also assume that at least some...
What features would push you towards re-operation for completion staging vs observation for a premenopausal woman with stage II borderline tumor of the ovary with capsule rupture and no other evidence of gross residual disease?
Probably none. What's the benefit of upstaging her with another surgery if there's nothing to resect on imaging, and I'm assuming is asymptomatic?
Would weak PR positivity make you consider adjuvant endocrine therapy for a young pre-menopausal woman with a HER2 positive, ER negative breast cancer?
I would discuss the uncertainties, and would offer tamoxifen at the most (I would not subject the patient to the toxicities of OFS and AI). I would also have a low threshold to discontinue tamoxifen if there are toxicities. If there are minimal to no side effects, it may be worthwhile getting the th...
When do you choose dose-dense chemotherapy v. q3 week therapy in advanced epithelial ovarian cancer?
In our recent OGR, we suggested an approach to deciding which patients might be appropriate for considering the dose-dense regimen in the first line setting (Figure 2). The dose-dense JGOG regimen was shown to confer an overall survival advantage in newly-diagnosed patients with advanced disease (es...
Would the need for infliximab/MTX/nonsteroidals to control initial irAE affect your decision to rechallenge these patients with ICI?
Infliximab and methotrexate are generally used in irAE grades 3 or 4, or in grade 2 irAEs that are refractory to initial treatment with steroids. Methotrexate is typically used for irAEs of the musculoskeletal system, such as inflammatory arthritis or myositis. Infliximab tends to be used in the set...
For patients with cT1-T3 cN0 cM0 mid/low rectal cancer seeking organ preservation, what treatment approach do you recommend?
This is an important question; however, the answer is unknown. The key outcome that should be the focal point for the best treatment option, is which treatment strategy results in the most optimal patient reported quality of life and bowel function. Currently, this remains void of prospective, rando...
What would be your radiotherapy plan for a patient with recurrent GBM (WHO grade 4, IDH wild-type) s/p 2 prior resections with no prior radiation?
The scenario described in this clinical case is not uncommon. I have had patients who either live several hours away from our center or were unwilling to receive the Stupp protocol of 60 Gy in 6 weeks and were successfully treated with 3 weeks of hypofractionated RT (HFRT). HFRT over 1–3 weeks (25 G...