Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
In pure red cell aplasia, does peripheral blood-positive IgG for parvovirus have significance if persistently positive on retesting, but IgM and PCR are negative?
It is unlikely to be related; IgG will reflect past infection. The IgM is more reliable. I would treat this as autoimmune or idiopathic PRCA.
In pure red cell aplasia, does peripheral blood-positive IgG for parvovirus have significance if persistently positive on retesting, but IgM and PCR are negative?
It is unlikely to be related; IgG will reflect past infection. The IgM is more reliable. I would treat this as autoimmune or idiopathic PRCA.
What hydroxyurea dose do you target for HbSC disease?
Based on results reported recently, hydroxyurea at an average dose of 20.5 mg/kg/day appeared to reduce substantially the rate of acute painful episodes and other sickle cell disease-related events in both adults and children with HbSC disease (Dei-Adomakoh et al., PMID 39647172). Previous studies a...
What are your top takeaways in GU Cancers from ESMO 2024?
1. Tivozanib–nivolumab vs tivozanib monotherapy in patients with renal cell carcinoma (RCC) following 1 or 2 prior therapies including an immune checkpoint inhibitor (ICI): Results of the phase III TiNivo-2 study. This trial confirmed (along with CONTACT-03: cabozantinib +/- atezolizumab) that cont...
While we await the completion of RTOG 1008, what instances do you offer chemotherapy for salivary gland tumors?
There are no current prospective data about adding chemotherapy to definitive or adjuvant RT for high-grade salivary gland tumors. Data from the National Cancer data base suggested no improvement of post-op CRT compared with RT (Amini A et al, Jama Otolaryngol-HN Surg 2016), however there were more ...
How would you approach adjuvant treatment in a patient with completely resected undifferentiated pleomorphic sarcoma of the chest wall that recurred after 2 years, initially treated with neoadjuvant radiation and resection?
There is no evidence to support adjuvant treatment after re-resection. In the case of recurrence, we prefer to biopsy the mass to prove recurrence and obtain tissue (for NGS). In the case of recurrence, if we were to give systemic therapy, then we would favor neoadjuvant chemotherapy- provided this ...
Do you have a higher threshold regarding when to hold bevacizumab for proteinuria in patients who had known baseline proteinuria from diabetic nephropathy?
This is an interesting question. It’s not uncommon to have patients with cancer who have other underlying conditions that may lead to proteinuria. I don’t have a higher or lower threshold to recommend holding VEGF inhibitors, but in all patients who are on them who develop proteinuria, the degree of...
Can radiation therapy alone for localized recurrence of high-grade B-cell lymphoma be considered for those that previously received rituximab-based chemotherapy?
High-grade B-cell lymphomas are distinct entities no longer classified as "diffuse large B-cell lymphoma" by the WHO. They include: High-grade B-cell lymphoma with MYC and BCL2 and/or BCL6 rearrangements (often referred to as double hit or triple hit lymphoma). High-grade B-cell lymphoma, NOS (thes...
How do you respond to a patient who asks "Why do I still need breast radiation after chemotherapy if chemotherapy treats the whole body?"
Perhaps one of the best arguments supporting RT in breast cancer is the not-that-often cited Scottish Trial that randomized women to postoperative RT or chemotherapy following breast conservation; the breast failure rate following adjuvant chemotherapy alone approximated 30% with short follow-up. Ob...
How would you treat an elderly patient with biopsy proven extensive non-resectable metastatic pseudopapillary pancreatic tumor?
This response is for cases that curative surgery or debulking surgery is not an option. These patients may respond to targeted therapy or hormonal therapy. We perform genomic profiling. If alterations are present which lead to the activation of PI3K/AKT/mTOR pathway, we use everolimus or temsirolimu...