Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Is there any role for re-biopsy and NGS for patients with NSCLC and KRAS G12C at time of progression after first line therapy before starting sotorasib, or after progression on sotorasib?
This is a great question and one that will come up more frequently. There clearly is a role for biopsy at the time of progression on targeted therapies in other driver alterations in NSCLC, and in limited data; to date, we know that occasionally there are resistance mechanisms to KRAS inhibitors tha...
How would you approach the staging and treatment of extranodal marginal zone lymphoma of left and right lacrimal gland?
This entity is described in literature as "ocular adnexal lymphoma". I usually screen those patients for Chlamydia infection and would empirically consider a 3-week course of doxycycline especially if the disease is indolent behaving clinically and there is prior serologic evidence of Chlamydia infe...
How would you approach the staging and treatment of extranodal marginal zone lymphoma of left and right lacrimal gland?
This entity is described in literature as "ocular adnexal lymphoma". I usually screen those patients for Chlamydia infection and would empirically consider a 3-week course of doxycycline especially if the disease is indolent behaving clinically and there is prior serologic evidence of Chlamydia infe...
Would you consider doing Oncotype for a locoregional recurrence of ER positive breast cancer?
To re-phrase the question, would evidence that a local recurrence is biologically more aggressive than the primary affect our recommendations about administering adjuvant chemotherapy in a patient who recurred on adjuvant endocrine therapy, especially if she had never received adjuvant chemotherapy?...
In which patients with MGUS do you recommend a kidney biopsy to evaluate for MGRS?
If a patient has unexplained renal disease, and this could be interstitial or glomerular, and an MGUS, I strongly consider it. I typically try to get heme to do a bone marrow biopsy first because their findings may obviate a renal biopsy if they find something (although sometimes they may find low-g...
What treatment options do you consider if eosinophilia with end organ dysfunction persists with q8 week dosing of benralizumab and you can't obtain approval for q4 week dosing?
Depending on the degree of eosinophilia and end-organ dysfunction, if the patient is not already on oral steroids, they probably should be pending a new plan for a steroid-sparing agent. Is the diagnosis more consistent with HES or EGPA? Has the patient failed mepolizumab 300 mg? There is good data ...
Do you prefer to use the FAST or FAST-Forward regimen when treating stage I breast cancer with an ultra-hypofractionated approach?
We favor APBI like the Florence regimen but if technically not suitable, then FAST-Forward.
How would you treat an elderly, transplant-ineligible patient with recurrent DLBCL?
There is no single standard of care in the treatment of transplant-ineligible relapsed or refractory DLBCL in the second line. Many regimens would be considered relevant considerations here, including rituximab, gemcitabine, and oxaliplatin; bendamustine and rituximab; rituximab and dose-adjusted EP...
How would you treat an elderly, transplant-ineligible patient with recurrent DLBCL?
There is no single standard of care in the treatment of transplant-ineligible relapsed or refractory DLBCL in the second line. Many regimens would be considered relevant considerations here, including rituximab, gemcitabine, and oxaliplatin; bendamustine and rituximab; rituximab and dose-adjusted EP...
How would you approach a patient with metastatic breast cancer with extensive skin involvement?
The issue of extensive skin involvement in metastatic breast cancer can be very challenging. Many factors come into play including whether the patient has had a mastectomy or has an intact breast as well as whether previous radiation has been delivered. For a previously untreated intact breast: Sur...