Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How would you approach patients with high risk mucoepidermoid carcinoma (high grade) of the parotid gland for optimal adjuvant treatment?
Would be nice to know all the risk factors - margins, PNI, etc.Due to high-risk features, adjuvant RT is appropriate and guideline-concordantHowever, there is no strong supporting evidence to add adjuvant chemo as salivary gland cancers are typically not chemo-sensitive.Published real-world data suc...
Is there any evidence for amyloid/amyloidosis causing a spurious/false PSA reading?
This is an excellent question.Our group has been involved with amyloid/radiation effects in patients with Alzheimer’s disease Turn our initial run-up and through our most recent reviews, I have not seen any significant publications nor have I seen clinical situations that this addresses, although am...
Is there any evidence for amyloid/amyloidosis causing a spurious/false PSA reading?
This is an excellent question.Our group has been involved with amyloid/radiation effects in patients with Alzheimer’s disease Turn our initial run-up and through our most recent reviews, I have not seen any significant publications nor have I seen clinical situations that this addresses, although am...
What is your preferred systemic treatment for patients progressing during or soon after completion of consolidation durvalumab for unresectable NSCLC?
This is an excellent question for which (to my knowledge) no randomized prospective data is available. As this is a frequent clinical scenario, one would hope that investigators in the thoracic oncology field would perform such a study in the future. That being said, I can see the rationale for givi...
How would you manage a young woman with vulvar langerhans cell histiocytosis and positive margins after wide local excision?
It is a complex situation/question, with no major existing studies to answer it directly. Further management depends on various factors- are there other sites of disease on full-body PET CT scan? Is further surgery possible without any disfigurement or major cosmetic issues? If localized disease onl...
How would you approach langerhans cell histiocytosis involving a single bone site after resection?
The outcomes for single-site LCH in adults are generally excellent. However, there is still a small risk of relapse. At this time, factors predicting relapse are unknown. It is recommended to ensure that it is truly a single-site disease by FDG PET scan and there is no diabetes insipidus. If yes, th...
Excluding CLL, in which patients would you screen for hypogammaglobulinemia?
Patients I screen for hypogammaglobulinemia include those with: gammaglobulin gap (total protein-albumin) less than two; advanced multiple myeloma or mantle cell lymphoma; patients who have received CAR T cells or bispecific antibodies against BCMA or CD20.
Excluding CLL, in which patients would you screen for hypogammaglobulinemia?
Patients I screen for hypogammaglobulinemia include those with: gammaglobulin gap (total protein-albumin) less than two; advanced multiple myeloma or mantle cell lymphoma; patients who have received CAR T cells or bispecific antibodies against BCMA or CD20.
How is monoclonal gammopathy of renal significance (MGRS) different from myeloma kidney?
The terminology around renal failure and myeloma is confusing and sometimes unnecessarily complicated. Here is how I approach it: Light chain (cast) nephropathy - This is from toxic injury to the nephron tubules from excess light chains. This is usually picked up on biopsy or can be ascertained fro...
How is monoclonal gammopathy of renal significance (MGRS) different from myeloma kidney?
The terminology around renal failure and myeloma is confusing and sometimes unnecessarily complicated. Here is how I approach it: Light chain (cast) nephropathy - This is from toxic injury to the nephron tubules from excess light chains. This is usually picked up on biopsy or can be ascertained fro...