Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Can immune checkpoint inhibitors be safely given in a patient with chronic GVHD?
If the patient has active chronic GVHD the risk-benefit ratio of immune checkpoint blockade needs to be carefully assessed since there are well documented instances of severe GVHD flairs or immune-related adverse effects - in a patient on chronic immune suppression and quiescent GVHD we recommend no...
What treatment would you offer for patients with metastatic NSCLC (adenocarcinoma) who are EGFR positive AND PD-L1 >50%, who fail first line EGFR therapy (and are negative for T790M mutation)?
There are many clinical trial approaches that are evaluating immunotherapy among patients with EGFR mutations. Yet, there is little data to date of large populations of patients with long lasting responses to single agent PD-1 or PD-L1 inhibitors in the setting of EGFR mutations. Outside of a clinic...
Do you use anti-microbial prophylaxis when you prescribe ibrutinib?
Traditionally, H.Zoster and PJP prophylaxis was more routinely administered in CLL patients receiving chemoimmunotherapy as these regimens were typically more myelosuppressive as well as immunosuppressive. In the era of the novel BCR receptor agents with the approval of ibrutinib and idelalisib and ...
Do you use anti-microbial prophylaxis when you prescribe ibrutinib?
Traditionally, H.Zoster and PJP prophylaxis was more routinely administered in CLL patients receiving chemoimmunotherapy as these regimens were typically more myelosuppressive as well as immunosuppressive. In the era of the novel BCR receptor agents with the approval of ibrutinib and idelalisib and ...
What would you offer as adjuvant therapy for a resected stage IIIB adeno NSCLC in a patient who refuses chemotherapy?
Patients with stage III NSCLC are at very high risk for recurrence, and in this situation, I would make sure that your discussions with the patient highlight this clearly. My usual thought is that if a patient can tolerate and recover from lobectomy/resection, then that is a reasonable indication th...
In light of the recent results from STAMPEDE and LATITUDE, to which patients with newly diagnosed metastatic prostate cancer are you offering up-front abiraterone vs. up-front docetaxel?
The high volume patients who were getting chemo will be offered abiraterone provided the cost of the drug will be covered. I will hold off on the low volume patients for now- the median rPFS for the low volume patients on ADT alone on the GETUG 15 was 21 months. I would also not treat M0 patients . ...
Under what circumstances do you consider a biopsy for a patient with a new brain lesion who is undergoing active systemic cancer treatment?
Indications for biopsy would be rare: First - if the brain lesion is dural-based and slow-growing, and the patient has excellent systemic control. Second - if the brain lesions are progressing despite standard radiation therapy. Third - if control of CNS disease is being done using CNS-penetrating t...
What chemotherapy would you consider to treat platinum resistant high grade serous ovarian cancer in patients with a low grade MDS from prior platinum/PARPi?
Before making a recommendation to this patient, a basic understanding of treatment related MDS/AML is needed, along with a clarification of the meaning of “low risk of progression to acute myeloid leukemia (AML)”. My main goal would be to avoid therapy with a demonstrated risk of treatment related M...
Do you hold nivolumab and ipilimumab when giving palliative radiation to abdominal targets?
This is similar to the question of whether you should hold bevacizumab for palliative radiation. You cannot really change the biologic effects of these agents immediately by holding them. The toxicity has been repeatedly shown to be minimal in trials where radiation has been included with concurrent...
Are there scenarios that new visits/consults with patients can be done virtually amidst the COVID-19 outbreak?
Starting 3/16, we began offering lower-complexity / lower-risk patients the option of having a Tele-medicine consult vs re-scheduling to a later date. This offer has been extended broadly to all new consults at our facility when the provider indicates that s/he can extend comparable service virtuall...