Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How would you approach therapy for a solitary fibrous tumor of the orbit with residual disease (10%) after surgery?
The discussion about the possibility of complete resection, even if it involves orbital exenteration needs to happen since that is the only potentially curative treatment. If surgery is not an option or if it is deemed unacceptable by the patient, SFT is indeed radiosensitive. The discussion of the ...
How would you manage IVF using ovarian stimulation in a woman with a prior estrogen related thrombotic event?
This is a very important question. In general, guidelines do not necessarily cover this very specific area. A couple of important points to think about are that (1) women with a history of VTE provoked in the setting of estrogen therapy – for example, contraceptive use – are advised to undergo pharm...
How would you manage IVF using ovarian stimulation in a woman with a prior estrogen related thrombotic event?
This is a very important question. In general, guidelines do not necessarily cover this very specific area. A couple of important points to think about are that (1) women with a history of VTE provoked in the setting of estrogen therapy – for example, contraceptive use – are advised to undergo pharm...
Do you adjust chemotherapy dose if >=10% change in calculated dose, weight, BSA, or if any of these three parameters are met?
Our institution has a policy of adjusting chemotherapy doses if there is a 10% change in calculated dose. Since some drugs are based on weight and some on BSA, it gets complicated if we stick with one versus the other. Also, this practice aligns with ASCO recommendations.
When do you offer adjuvant chemotherapy after wide-local excision for soft tissue extremity sarcomas?
High risk extremity and superficial trunk STS, AJCC stage 3. Data is more convincing in Sarculator, which projected a risk of recurrence higher than 40%. If resection has already happened, adjuvant XRT has to follow first before adjuvant chemotherapy.
What is the risk of radiation therapy to an abdominal aortic aneurysm infiltrated by lymphoma?
I have no personal experience treating an AAA infiltrated with lymphoma. I believe, however, it is appropriate to draw an analogy with treating stomach or bowel involvement with lymphoma. In this situation, chemotherapy may well result in perforation due to rapid tumor shrinkage, whereas fractionate...
How would you approach a patient with DCIS (ER/PR/HER2 negative) with microinvasion in a SLN that is HER2 positive?
Sentinel lymph node involvement in cases of DCIS without micro-invasion is rare, and sentinel LN biopsy is generally not performed. Reported studies have shown SLN involvement rates of 2-3%, and they are usually micro-invasion, as in this case. Once micro-invasion is detected in SLN, management shou...
How would you manage a patient with sickle cell disease who is infected with COVID-19?
We have limited knowledge about this management. The Sickle Cell Disease Association of America's Medical and Research Advisory Committee has issued a provider advisory. Also, Dr. Julie Paniepento has created a registry that can be viewed in real time here: https://covidsicklecell.org/ In general, t...
How would you treat a patient with biopsy-proven recurrent urothelial bladder cancer with M1a disease (limited to retroperitoneal nodal disease)?
Systemic therapy with either clinical trial, or chemotherapy (ideally cisplatin-based or carboplatin/gemcitabine if cisplatin-unfit), or immune checkpoint inhibitor (if it is first line treatment setting and cisplatin-unfit, options include either pembrolizumab or atezolizumab, if either 'PD-L1 high...
How would you manage a patient with primary CNS lymphoma who received R-MTX followed by autologous transplant with systemic relapse 5 years later for which R-Pola-CHP was given now followed by CNS relapse?
Dr. @Dr. First Last - certainly an interesting and unusual scenario! I'm presuming that the patient is fit for intensive approaches. This is a patient whom I would consider for CAR-T as a treatment of multiply relapsed DLBCL. Depending on the symptomatic and anatomic burden of the CNS disease, debul...