Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Would you consider chemoimmunotherapy (CP-Pembro-AC) in triple negative breast cancer if tumor is not palpable on physical exam?
KN522 regimen is approved for cT2 or greater (tumor >2cm) regardless of nodal involvement or cT1c with nodal involvement. The tumor size can be determined by a physical exam or radiologic assessment or both. Therefore, it is perfectly fine to use KN522 regimen if the tumor is not palpable as long as...
How would you manage a patient who develops acute stroke during neoadjuvant chemotherapy with KEYNOTE-522 for Stage III triple negative breast cancer?
I will try to provide some data for discussion, but also welcome comments from other experts and opinions. I'm assuming this is a younger patient without known risk factors and that an assessment for things like A. Fib, PFO, and DVT have been performed.Chemotherapy has long been associated with thro...
How would you manage a patient who develops acute stroke during neoadjuvant chemotherapy with KEYNOTE-522 for Stage III triple negative breast cancer?
I will try to provide some data for discussion, but also welcome comments from other experts and opinions. I'm assuming this is a younger patient without known risk factors and that an assessment for things like A. Fib, PFO, and DVT have been performed.Chemotherapy has long been associated with thro...
Should you consider thromboprophylaxis, even for low-dose lenalidomide maintenance, post-autologous transplantation?
In the event there are no adverse contraindications for the use of thromboprophylaxis, yes, I recommend the use of a minimum of 81 mg of aspirin daily with a low dose of lenalidomide. In this meta-analysis (Chakraborty et al., PMID 31913498), the risk of venous thromboembolism was low with a low dos...
Should you consider thromboprophylaxis, even for low-dose lenalidomide maintenance, post-autologous transplantation?
In the event there are no adverse contraindications for the use of thromboprophylaxis, yes, I recommend the use of a minimum of 81 mg of aspirin daily with a low dose of lenalidomide. In this meta-analysis (Chakraborty et al., PMID 31913498), the risk of venous thromboembolism was low with a low dos...
How would you approach a young person with JAK2 V617F positive essential thrombocytosis with otherwise low risk features?
The first question in this situation is what is the JAK2 V617F neutrophil quantitative allele burden (NAB)? It must be less than 50% for a diagnosis of essential thrombocytosis (ET). Second, are we dealing with a man or woman? Men with so-called "ET" are much more likely than women to develop myelof...
How would you approach a young person with JAK2 V617F positive essential thrombocytosis with otherwise low risk features?
The first question in this situation is what is the JAK2 V617F neutrophil quantitative allele burden (NAB)? It must be less than 50% for a diagnosis of essential thrombocytosis (ET). Second, are we dealing with a man or woman? Men with so-called "ET" are much more likely than women to develop myelof...
When do you consider cytoreduction in patients with Essential Thrombocytosis?
I consider cytoreduction for patients with ET if they are at high risk of thrombosis based on the R-IPSET score. For intermediate risk patients, I factor in medical comorbidities and symptoms to help decide to initiate therapy. I don't start cytoreduction based on a platelet count alone. If a patien...
When do you consider cytoreduction in patients with Essential Thrombocytosis?
I consider cytoreduction for patients with ET if they are at high risk of thrombosis based on the R-IPSET score. For intermediate risk patients, I factor in medical comorbidities and symptoms to help decide to initiate therapy. I don't start cytoreduction based on a platelet count alone. If a patien...
Would you add immunotherapy to chemotherapy in the adjuvant treatment of resected small cell lung cancer?
In the absence of data in this space, no. The improvements observed in ES-SCLC in IMpower133 and CASPIAN with the addition of ICI were modest at best. Pending results from ADRIATIC and NRG LU005 for benefits in the limited stage population, but this would still require a leap of faith to the adjuvan...