Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
What are your current recommendations for treatment of symptomatic splenomegaly in the setting of myelofibrosis when splenectomy is not an option?
I use low dose, typically 50cGy per fraction for 4-6 fractions, done in 2 fractions per week; need to check platelets each week during course.
What is your experience with Gelclair for oral mucositis during head & neck radiotherapy?
I used Gelclair for my patients regularly till a few years ago. However, I did not find a significant difference in the rates of mucositis among those who did and did not use this product. That is my anecdotal experience and I would be curious to hear other thoughts from those who are routinely reco...
How would you treat a patient with a granular cell tumor of the breast with positive margins following excision?
I would recommend a re-excision to widely negative margins. I would not radiate.
How do you treat SNUC?
There’s no standard treatment. Suitable for gross total resection: surgery and postop RT and concomitant chemo.Not suitable for GTR: chemo RT or induction chemo and reevaluate for surgery and postop RT chemo.
If using GCSF with mFOLFIRINOX, would you ever use it during day 1?
Assuming you are talking about a pegylated GCSF product, we give it on day 4 of this regimen (the day after 5-FU pump ends). We have no problems with reimbursement for that (places the drug 11 days prior to the next dose). I would not be comfortable with a day 1 delivery.
How do you counsel patients with metastatic TNBC on their various treatment options after progression on first line regimens?
The choice of a regimen would typically weigh: Expected efficacy. It is important to acknowledge that outside of the 1st and 3rd line settings, there may not be much data to guide the selection of one regimen over another. Expected toxicity. This includes side effects such as neuropathy, etc but wo...
Do you give adjuvant chemotherapy for an incidental cholangiocarcinoma found at time of liver transplant (done for HCC or other reason) in the explanted liver?
I am not sure I would offer chemo here. You don’t state the T stage of the tumor or if nodes were involved, both of which are critical in understanding the risk of relapse. Regardless, chemo in someone who is in the fragile state of a newly transplanted liver has a risk of the chemo causing rejectio...
What are your top takeaways from ASCO GI 2024?
ALL CTDNA IS NOT CREATED EQUAL (the only way I reconcile the negative findings of COBRA using a tumor-uninformed assay in predicting the efficacy of adjuvant chemo in stage II colon cancer: https://www.cancernetwork.com/view/ctdna-does-not-confer-chemo-efficacy-in-stage-ii-crc-following-surgery wit...
When would you consider aspirin for long term management of unprovoked VTE after initial therapeutic anticoagulation?
The WARFASA trial randomly assigned patients with first unprovoked VTE who had completed 6-18 months of anticoagulation to 2 additional years of aspirin versus placebo. While the study demonstrated a 40% reduction in recurrent thrombotic events, the rates of VTE in those receiving aspirin were still...
How do you approach duration of immunotherapy in patients with metastatic NSCLC?
If someone manages to continue the ICI maintenance up to 2 years without progression, I am comfortable counseling the patient to stop the ICI treatment as per the regulatory approval indication. I have had occasionally, patient's anxiety level driving the desire to continue beyond the 2 years treatm...