Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Would you change treatment approach for rectal cancer with an associated intussusception?
If the patient has obstruction, I probably would favor surgery first. If not, then I'd treat it as usual. It's a judgment call though.
Would you give adjuvant anti-hormonal therapy after bilateral mastectomies for multifocal/multicentric high grade DCIS?
No. Since DCIS does not metastasize, the purpose of endocrine therapy, with either tamoxifen or and AI after DCIS, is to decrease the risk of local recurrence and new breast cancers. Having bilateral mastectomy decreases the risk by >90%, such that the additional benefit of preventive endocrine ther...
Would you continue durvalumab beyond 12 months in an oligometastatic NSCLC patient treated with concurrent CRT followed by consolidation durvalumab after treating a single metastatic site?
There are really a few questions here. The first is duration of durvalumab, and I agree with prior answer by @Dr. First Last that stopping at 1 year is appropriate given that was specified in PACIFIC (though only 42% of patients actually completed 1 yr of durvalumab in the study). Then there is the ...
Would you recommend oral or intravenous iron in a chronic kidney disease stage 4 patient who is not on an ESA and has a hemoglobin of 12.7 g/dl and an iron saturation of less than 20%?
I would not necessarily treat this patient with iron at all. I would check serum ferritin. If low would do a colonoscopy or look for causes of iron deficiency. If not low would observe. In general though for patients with CKD (not on dialysis yet) who need iron therapy, I would try oral iron first. ...
For incidentally found stage I indolent non-Hodgkin's lymphoma in young patients, which subtypes would more strongly warrant a consideration for curative-intent radiation?
In general, national guidelines recommend definitive RT for early-stage, low-grade NHLs. These are a diverse collection of diseases with different natural histories and outcomes after treatment. In brief... 1. Follicular lymphoma - typically a disease of older adults with ~20% presenting with early-...
For plasmablastic lymphoma responsive to treatment except for a recurrent lymph node eroding into a vertebral body at the end of chemotherapy, would you cover the entire vertebral body in your CTV, or treat only the involved lymph node with a margin?
Plasmablastic lymphoma is an aggressive NHL that typically occurs in the H&N region, typically in immunosuppressed individuals. Most patients present with advanced disease. The role of RT is not firmly established. That said, in a patient only achieving a PR to systemic therapy with localized residu...
Does variable allele frequency (VAF) of JAK mutation affect your clinical decision-making in MPN in any scenario?
The JAK2 driver mutation quantitative allele burden is an important feature in the clinical management of PV, ET, and PMF patients. First, however, some prefatory comments: All MPN driver mutations are classified as variant because they contain a change in their DNA not normally found in the particu...
Does variable allele frequency (VAF) of JAK mutation affect your clinical decision-making in MPN in any scenario?
The JAK2 driver mutation quantitative allele burden is an important feature in the clinical management of PV, ET, and PMF patients. First, however, some prefatory comments: All MPN driver mutations are classified as variant because they contain a change in their DNA not normally found in the particu...
What systemic therapy and dose adjustments would you implement for patients with pancreas cancer and cirrhosis with pancytopenia?
Of the five drugs available to us, two (abraxane and irirnotecan) are a challenge in liver dysfunction with the added thrombocytopenia. The question becomes, what is the real value of a single drug versus a combination in this setting when it comes down to clinically meaningful efficacy? Capecitabin...
Do you consider starting hydroxyurea in a patient with hemoglobin S-beta thalassemia with chronic kidney disease secondary to FSGS?
I consider initiating hydroxyurea in all individuals with sickle cell disease, even if they have rare or infrequent acute pain episodes. This is because pain is just one manifestation of the disease and ongoing hemolysis leads to a state of chronic inflammation characterized by cytokines, activation...