Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Will you offer olaparib + abiraterone for all patients with metastatic castrate resistant prostate cancer based on results of PROPEL trial?
PROpel is clearly positive for its primary endpoint of delaying rPFS significantly in ALL first line mCRPC patients above and beyond abiraterone and prednisone alone. The delay of 8-10 months over an active comparator is significant both statistically and clinically, and is similar to the improvemen...
What methods do you use to prophylactically reduce radiation dermatitis for head and neck irradiation?
My approach has been: Start Remedy (less greasy but less effective) and/or Aquaphor (more greasy but more effective) 3-4x daily at beginning of RT. Try to use Aquaphor at least at night when the greasiness is less bothersome. If patients have some other alcohol-free/non-anti-oxidant product they re...
What is your goal ferritin level in pregnancy?
The goal is really to avoid iron deficiency and <30 best defines this state. Need to be wary of circumstances such as inflammation where the ferritin level may be falsely high even in the setting of reduced body iron.
When is the ideal time to start adjuvant nivolumab after radical surgery in urothelial carcinoma?
In the reported and ongoing adjuvant therapy trials, patients must have had radical surgery (R0, with negative surgical margins) within 120 days before randomization. However, it is biologically rational to target initiating therapy as soon as he/she is fit for nivolumab following surgery (data in t...
Can TPO agonists, like avatrombopag or lusutrombopag, be used for patients with chronic thrombocytopenia and new acute portal vein thrombosis?
A caveat before answering - these tend to be very difficult clinical situations in a population that often has cirrhosis and has a very difficult-to-predict hemostatic picture (whether they are prohemorrhagic or prothrombotic from the underlying liver disease).I would refer you to some of the excell...
How do you approach adjuvant therapy for patients with advanced ovarian cancer who undergo interval debulking surgery following six cycles of neoadjuvant chemotherapy?
If viable tumor at the time of surgery and patient has acceptable performance status then I would treat 2-3 more cycles of chemo followed by maintenance therapy. However, if no viable tumor at the time of surgery then I would forego IV chemotherapy and start maintenance postoperatively depending on ...
In what situations do you use G-CSF for patients undergoing allogeneic HSCT to facilitate engraftment?
A word of caution regarding the use of G-CSF in the setting of using ATG for GVHD prophylaxis. We published in 2021 (Orfali et al., PMID 34507002) a multicenter retrospective analysis of the interaction between ATG and post-transplantation G-CSF on allogeneic HCT outcomes for myeloid malignancies an...
Do you give two or three cycles of cisplatin to patients with H&N squamous cell carcinoma receiving chemoradiation with Q3 week cisplatin?
The data from an old RTOG study show that a total of 2 cycles of cisplatin 100 mg/m2 concurrently with accelerated RT is as good as 3 cycles with standard RT. My experience is that most patients do not tolerate cycle 3 of high dose cisplatin and therefore, not given. Personally, I do not routinely u...
Do you refer all patients with new findings of CNS or epidural mets/tumor to ED for evaluation or are there some that can be managed completely outpatient?
Interesting question: Sending patients to the ED for non-emergent conditions is not advised. Our EDs around the country are struggling for a variety of reasons (e.g., they are often holding patients awaiting placement or admission), thus our society will benefit by us avoiding sending patients to t...
How would you sequence lifileucel (TIL therapy) in a patient with metastatic melanoma who is BRAF wild-type (BRAF WT) and progressed on adjuvant Nivolumab?
The FDA-approved label for Amtagvi is for BRAF wild-type metastatic melanoma patients who progressed following anti-PD-1 containing immune checkpoint therapy. Thus, progression following ipi/nivo would certainly meet the indication for TIL therapy. What you will have to assess though is whether the ...