Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Would you consider giving neoadjuvant therapy using a KEYNOTE-522 regimen to someone with cT1c cN0 TNBC?
I would treat a larger cT1cN0 TNBC in a young, fit patient with neoadjuvant ddAC-T. As you point out, such a patient would not have been eligible for KEYNOTE-522 (which only enrolled stage II-III patients), and I do not think the added potential toxicity of the pembro and carbo are worth the unknown...
How do you treat stage I head of pancreas adenocarcinoma in an older patient who is not a candidate for chemotherapy or surgery?
The question of how to manage an elderly patient who is not a candidate for chemotherapy or surgery is a really important one. I would argue that this question is not unique to an elderly patient but should be asked for ANY patient who cannot receive systemic therapy. We are fortunately living in a ...
Can the presence of elevated ring sideroblasts (20%) on a bone marrow biopsy without dysplastic changes or suspicious molecular mutations still be indicative of an underlying MDS in a patient with unexplained anemia?
It is easy to forget that this clinical presentation was the rule not the exception in the pre-genomic era. We knew then that idiopathic sideroblastic anemia could be congenital or acquired due to drugs, toxins, or disorders of porphyrin or hemoglobin synthesis, or could rarely be clonal (using G6PD...
Can the presence of elevated ring sideroblasts (20%) on a bone marrow biopsy without dysplastic changes or suspicious molecular mutations still be indicative of an underlying MDS in a patient with unexplained anemia?
It is easy to forget that this clinical presentation was the rule not the exception in the pre-genomic era. We knew then that idiopathic sideroblastic anemia could be congenital or acquired due to drugs, toxins, or disorders of porphyrin or hemoglobin synthesis, or could rarely be clonal (using G6PD...
How would you approach treatment for a cT1N0M0 urothelial carcinoma of the ureter, high grade in a non-surgical candidate due to medical comorbidities?
Although there is limited data using radiation therapy or chemo-radiation in UTUC, in a non-surgical candidate, this may be a reasonable approach to consider in selected patients. This would be an extrapolation from the promising data from RTOG 0926, a single arm, phase II trial investigating trimod...
Is it unusual to have isolated LDH elevation and normal HCG and AFP in non-seminomatous germ cell tumor (embryonal carcinoma)?
It's hard to generalize: the details of the case matter. It is not very unusual to have an isolated LDH elevation. LDH is extremely non-specific. 101 different things can make LDH go up and this limits its usefulness as a tumor marker. Elevation of LDH on day 1 of cycle one of first-line chemotherap...
Do you utilize Oncotype DX DCIS score to decide on the need and duration of endocrine therapy in patients with DCIS?
There is not enough data to use Oncotype Dx DCIS score routinely in practice and I personally don’t use it. Certainly, in patients with DCIS who get a simple mastectomy, it has no applicability since mastectomy is the definitive therapy for DCIS. In patients with lumpectomy, adjuvant breast radiatio...
How would you manage a new suspected brain metastasis in a patient with a distant cancer history?
So I think there are some details missing but generally, if there is a suspected brain metastases in a patient with distance cancer history and that biopsy/resection is not feasible, I would consider additional workup including extracranial imaging. If the suspected brain metastases is asymptomatic ...
Do you recommend concurrent or sequential radiation and chemotherapy for margin-positive, node negative NSCLC?
We recently looked at outcomes with sequencing of PORT and chemotherapy in patients with pN2 disease and R0, or pN2 R1/R2 resection in the NCDB (J Clin Oncol 2017 Dec 13:JCO2017744771). This group is not exactly the pN0 patient population that is the focus of this question, however, in the R0 pN2 gr...
Do you regularly incorporate oral cryotherapy in your practice for patients receiving oxaliplatin to decrease the risk of thermal hyperalgesia?
I personally am not opposed if a patient wishes to try it but I also am not a big believer. There are several issues here - the peripheral neuropathy will continue to be an issue overall, this study regressed to the mean over time and it’s a smaller study (although randomized which is very helpful)....