Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Is it safe to give thoracic irradiation to a patient with lung cancer previously treated with a VEGF inhibitor?
We did a study in patients getting VEGF inhibitors and SBRT. Anecdotally we had seen some impressive (small bowel necrosis requiring surgery) and unpredicted toxicity and we were looking for a common factor that tied them together. VEGF inhibition was that common factor. These are all patients treat...
In oligometastatic NSCLC with a solitary brain metastasis and lung primary amenable to SBRT, how would you sequence first-line systemic therapy versus local therapy to the lung after treatment of the CNS metastasis?
Would generally favor appropriate first-line systemic therapy whether that be immunotherapy +/- chemo vs. targeted therapy and if at least stable disease at the next surveillance imaging (~3 months), go ahead and consolidate with SBRT. I don't think it would be wrong to do SBRT upfront here but the ...
With the data from AALL1731, how is blinatumomab being implemented for SR and HR leukemia patients not previously planned/randomized to receive blinatumomab?
We have incorporated blinatumomab for most patients as two non-consecutive cycles. Once in maintenance, we have not uniformly added blinatumomab, although we have interrupted maintenance to offer blinatumomab to select patients (high-risk genetics or those who had significant treatment modifications...
Would you combine sutimlimab with bendamustine rituximab for cold agglutinin disease if patient continues to hemolyze during treatment?
In my experience, virtually all patients with true cold agglutinin disease respond to sutimlimab quite quickly. While there may be sub-clinical evidence of hemolysis for some time, generally hemoglobin improves to normal or close to this. Adding therapy to sutimlimab really depends upon the clinical...
Would you combine sutimlimab with bendamustine rituximab for cold agglutinin disease if patient continues to hemolyze during treatment?
In my experience, virtually all patients with true cold agglutinin disease respond to sutimlimab quite quickly. While there may be sub-clinical evidence of hemolysis for some time, generally hemoglobin improves to normal or close to this. Adding therapy to sutimlimab really depends upon the clinical...
What is the recommended treatment approach for stage III/IVA nasopharyngeal cancer that is p16 negative and EBV positive?
The recommended treatment approach for stage III/IVA EBV-positive nasopharyngeal cancer is induction chemotherapy with gemcitabine/cisplatin followed by concurrent chemoradiotherapy with cisplatin.This was established in a phase 3 trial that compared induction chemotherapy plus concurrent chemoradio...
In what situations would you consider doublet chemotherapy in treatment of a premenopausal de novo metastatic TNBC?
I use a doublet in patients with symptomatic disease or large disease burden. Shortness of breath or pain from locally advanced disease and significant liver disease burden are typical examples. These are situations where a higher disease response matters for quality of life and improving symptoms ...
How do you monitor multiple myeloma in patients receiving dialysis?
In brief, it depends. I’ve had some patients on dialysis whose light chains completely normalize with treatment and continue to remain normal - and others where the light chains never drop below 100 mg/L even in the setting of MRD negativity. This probably has something to do with the fact that not ...
How do you monitor multiple myeloma in patients receiving dialysis?
In brief, it depends. I’ve had some patients on dialysis whose light chains completely normalize with treatment and continue to remain normal - and others where the light chains never drop below 100 mg/L even in the setting of MRD negativity. This probably has something to do with the fact that not ...
How do you treat newly diagnosed low volume metastatic hormone sensitive prostate cancer in light of new data from STAMPEDE presented at ESMO 2018?
In the prespecified subset of men with mHSPC and low volume of metastases (CHAARTED criteria of 4 or fewer bone metastases and no visceral metastases), there was a 32% improvement in overall survival (HR 0.68 95% CI 0.52-0.9) which was statistically significant and is clinically significant. Given t...