Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Would you offer a RET inhibitor to a patient with de novo metastatic, RET V706M mutant squamous cell lung cancer?
Yes, it should be effective.
How do you approach RA management in a patient who develops a new solid tumor while on therapy?
Risk-benefit ratios need to be individually assessed. There are several aspects to take into account: Choice of DMARD - Data on impact of various DMARDS on cancer recurrence or progression is scarce, especially for patients with active cancer. In general, there are few concerns for conventional DMA...
Would you rechallenge with cabozantinib in a patient with HCC after the development of a 6 mm gastrohepatic fistula without perforation or communication with the peritoneal cavity?
This is a tough situation. Based on the package insert for Cabozantinib, it can cause GI fistula and perforation in about 1% of patients and any grade 4 should prompt discontinuation of the drug label. The current gastrohepatic fistula without perforation could lead to recurrent abscesses in the liv...
Would you continue venetoclax indefinitely/until disease progression in patients treated with upfront venetoclax for TP53 mutated CLL?
First of all, for the del(17)(p13.1) and/or TP53 mutated CLL patients, venetoclax + obintuzumab may not be the best option based upon data from the CLL14 trial showing early PFS in this group as compared to what has been demonstrated in both up-front ibrutinib and acalabrutinib studies. However, we ...
Would you continue venetoclax indefinitely/until disease progression in patients treated with upfront venetoclax for TP53 mutated CLL?
First of all, for the del(17)(p13.1) and/or TP53 mutated CLL patients, venetoclax + obintuzumab may not be the best option based upon data from the CLL14 trial showing early PFS in this group as compared to what has been demonstrated in both up-front ibrutinib and acalabrutinib studies. However, we ...
How do you consider the role of probiotics for mucositis mitigation in patients receiving head and neck radiotherapy?
This is a very interesting study and I am excited to see continued studies into symptom mitigation for definitive chemoRT. I currently offer Ssk12 to my patients undergoing H+N RT (definitive or adjuvant). I see little potential downside as it is a relatively inexpensive intervention and they report...
How does your approach to subsegmental PE differ from segmental PE both diagnostically and therapeutically?
My approach to subsegmental PE and segmental PE generally tends to be very similar. I am aware of the CHEST guidelines which indicate patients can safely be observed with subsegmental PE, but like a recent study showed (Rouleau et al., PMID 37531107), uptake of these guidelines is slow and many pati...
How would you evaluate a pediatric patient referred to rule out cancer due to an isolated significantly elevated vitamin B12 level?
Would you recommend any adjuvant therapy for a premenopausal woman with ER+, microinvasive breast cancer who cannot tolerate tamoxifen?
I would explain that the benefits of tamoxifen are low, but it may help prevent a new cancer. If she has arthralgias before stopping treatment she may want to try acupuncture to see if it helps her with her symptoms. If she still does not tolerate it she should focus on lifestyle factors such as exe...
Do you evaluate patients for low health literacy prior to discussing treatment options?
To answer this question - I do not routinely evaluate for low health literacy in my patients. This may not be the correct approach, but here is my rationale. I assume low health literacy and work up from there during each consultation. Even patients who are highly educated and/or have a background i...