Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How does your management of ITP change when related to CLL?
The immune dysregulation associated with ITP is not necessarily a result of the CLL but occurs alongside and might be what underlies both disorders. The CLL clone is not making the antibody. ITP that persists despite a CR of the associated CLL should be treated as one would treat primary ITP. My fi...
What infections should we rule out in patients who develop diarrhea on immunotherapy?
Immunotherapy is known to be associated with immune-mediated diarrhea and colitis (IMDC). However, it remains unclear whether cancer patients undergoing immunotherapy are at a heightened risk for Clostridioides difficile colitis infection (CDI). A retrospective study focusing on patients treated wit...
How would you treat IIB ovarian carcinosarcoma which recurred locally at 1 month post initial debulking surgery, progressed through 2 cycles of adjuvant carbo/taxol, and is now s/p repeat debulking?
Platinum refractory ovarian cancers are incredibly challenging. In terms of more conventional chemotherapy options and based on the AURELIA trial, one could consider bevacizumab in combination with pegylated liposomal doxorubicin or topotecan. I would not use paclitaxel since the cancer is progressi...
Would you use bevacizumab in a metastatic RAS-mutant colon cancer, if the patient had a colon perforation that was resected?
The risk for bevacizumab-related bowel perforation has been reported and evaluated in multiple studies. The absolute number is a quick low. Here is one of the largest studies with 1,953 colorectal cancer patients who had bevacizumab treatment with median follow up of 20.1 months. Among the 1,953 pat...
What are your top takeaways from SGO 2024?
SGO 2024 was a great meeting with many excellent presentations. We are truly “moving the needle together”. The following presentations are each practice changing. Duska et al., PMID 38521086: Pembrolizumab plus chemoradiotherapy for high-risk locally advanced cervical cancer: randomized, double-bli...
How would you manage a cardiac metastasis from Merkel cell carcinoma?
I would first determine the extent of metastases and carefully determine the extent of the tumor in the heart (usually with cardiac MRI). I would also discuss the threat of the tumor to the heart with a cardiologist (if possible). If extensive metastases were present, I would suggest starting with i...
In which scenarios would you consider adjuvant chemotherapy for a patient with T1a N0 triple negative breast cancer?
This is indeed a tough situation and one that we may see more and more as our screening techniques keep getting better.I do consider giving adjuvant chemotherapy for T1ab TNBC and will discuss this option with my patients based on a few factors. Multiple retrospective studies have shown that the DFS...
What adjuvant therapy do you recommend for stage III colon cancer patients unable to tolerate 5FU regardless of modality/dose reduction?
There is no high-quality evidence to support adjuvant chemotherapy for colorectal cancer with a non-fluoropyrimidine regimen. For patients at high risk for colon cancer recurrence, effort should be taken to find a dose or mode of fluoropyrimidine administration that is feasible. For instance, bolus ...
Do you still order mpMRI for staging of prostate cancer in addition to PET-PSMA?
Yes, I still think the prostate MRI adds valuable information for target delineation and local staging. This position is consistent with a recent poll of GU specialists where about 90% of respondents believed that a prostate MRI was still necessary after a PET/CT (Gillessen et al., PMID 35450732).My...
With the CANOVA results in mind, would you continue using venetoclax in patients with multiple myeloma with t(11;14)?
TL;DR - I will still be using venetoclax for t(11;14) myeloma in the way that I have been doing so for some time, which is in combination with other active myeloma agents. I prefer venetoclax 400 mg daily, in combination with either carfilzomib 56 mg/m2 weekly or daratumumab SQ.Now the long version:...