Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Are you still recommending autologous stem cell transplantation (ASCT) for all eligible myeloma patients who achieve remission after induction with a quadruplet regimen?
Our institution still recommends upfront autologous transplant for most fit patients. We appreciate the recent results from CEPHEUS and BENEFIT, but if we believe that achieving MRD negativity is important, the addition of autologous transplant improves the rate of MRD negativity, which ultimately s...
Are you still recommending autologous stem cell transplantation (ASCT) for all eligible myeloma patients who achieve remission after induction with a quadruplet regimen?
Our institution still recommends upfront autologous transplant for most fit patients. We appreciate the recent results from CEPHEUS and BENEFIT, but if we believe that achieving MRD negativity is important, the addition of autologous transplant improves the rate of MRD negativity, which ultimately s...
In which patients with early stage rectal cancer treated according to the PROSPECT paradigm do you recommend adjuvant chemotherapy?
Great question and great observation. The most recent NCCN guidelines (version 1.2024-page REC-6) clearly listed neoadjuvant chemotherapy without radiation as an option for patients with no T4 disease eligible for sphincter-sparing surgery. After the neoadjuvant chemotherapy, if tumor regression is ...
Can olaparib be given with endocrine therapy in a metastatic BRCA-mutated, ER+ breast cancer patient?
In OlympiAD, olaparib was administered as a single agent vs chemotherapy in both triple negative and hormone receptor positive, HER2 negative advanced breast cancer. In the primary endpoint analysis, median PFS was longer with olaparib than chemotherapy (7.0 vs 4.2mo; HR 0.58 {0.43-0.80; p<0.001}). ...
How does one interpret an SPEP showing potentially obscured but non-quantifiable M-spike however an IFE showing monoclonal protein?
Not all patients with monoclonal gammopathies make a detectable paraprotein on SPEP, or, in some cases like IgA gammopathies, it may be 'hidden' in the beta-region of the SPEP, or the rare IgD and IgE gammopathies may be too low to detect on the SPEP. In addition, for the 15-20% of patients who have...
How does one interpret an SPEP showing potentially obscured but non-quantifiable M-spike however an IFE showing monoclonal protein?
Not all patients with monoclonal gammopathies make a detectable paraprotein on SPEP, or, in some cases like IgA gammopathies, it may be 'hidden' in the beta-region of the SPEP, or the rare IgD and IgE gammopathies may be too low to detect on the SPEP. In addition, for the 15-20% of patients who have...
Would you use sutimlimab for cold agglutinin disease/syndrome in patients with a concurrent hematologic malignancy?
The CARDINAL trial excluded patients with active malignancy, and thus in general I would not use sutimlimab in patients with CAD in context of a concurrent hematologic malignancy. Additionally, one would hope that treating the hematologic malignancy would address CAD mediated hemolysis, without requ...
Would you use sutimlimab for cold agglutinin disease/syndrome in patients with a concurrent hematologic malignancy?
The CARDINAL trial excluded patients with active malignancy, and thus in general I would not use sutimlimab in patients with CAD in context of a concurrent hematologic malignancy. Additionally, one would hope that treating the hematologic malignancy would address CAD mediated hemolysis, without requ...
How would you treat a patient with stage IIIA non-seminoma with an anaphylactoid reaction to etoposide during first cycle?
Etoposide is a very important drug in the curative regimens for metastatic testis cancer. BEP, EP, and VIP all incorporate etoposide. Arguably, it is possibly the second most active agent in germ cell tumors. Furthermore, it is highly synergistic with cisplatin. "Anaphylactoid" reactions can be see...
How do you manage a bladder cancer patient who had a partial cystectomy with a positive margin?
In fewer than 5% of bladder cancer patients, partial cystectomy along with neoadjuvant cisplatin-based chemotherapy can be considered for stage II (cT2, N0) disease with a single tumor in a suitable location and no presence of carcinoma in situ, where an adequate margin of soft tissue and an adequat...