Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
What is your preferred treatment for Stage IIA seminoma or IIB seminoma with LN <3 cm and normal tumor markers after orchiectomy?
Para-aortic nodal disease <5 cm is well treated with radiotherapy to PA+pelvis with boost tot eh nodes with high cure rates and minimal toxicity. >5cm best treated with BEP or EP chemotherapy. No role for RPLND in seminoma.
How does tissue subtype (ie hepatobiliary or intestinal) of ampullary carcinoma affect your treatment recommendations?
The intestinal subtype has a better prognosis and this can help with medical decision making. There is an inclination to treat intestinal types with lower-gi regimens and to treat the biliary types with pancreatic regimens. I don't believe there is good evidence to support this practice.
How long should surgery be delayed in a patient with localized, resectable pancreatic cancer who developed acute pancreatitis following EUS guided biopsy?
This is a great question, and the answer is yes, it should be delayed to avoid surgical complications, healing, etc. In such scenarios, surgery might be delayed up to 2 months or longer even, depending on the time to recovery. In our practice, we employ a neoadjuvant approach for these patients and ...
How would you treat metastatic squamous cell carcinoma of the gall bladder?
Pure squamous cell carcinoma (SCC) of the gallbladder is an extremely rare entity, approximately 1-3% of all gallbladder cases (85-95% are adenocarcinoma). There have been some case reports and the few retrospective studies available, comparing outcomes between adenocarcinoma and SCC were mixed (Roa...
How do you approach the management of capmatinib induced edema?
I don't know that I can give a comprehensive approach to the edema associated with capmatinib, but I can give a couple of observations that I think may help practitioners. Dose reduction can help if other measures don't accomplish what is wanted. I have several patients in their late 80s and early 9...
Which other agent would you consider for a patient with VEXAS who has failed methotrexate, multiple TNF inhibitors, Tocilizumab, and Ruxolitinib?
I would strongly consider referring for hematopoietic stem cell transplant. The NIH/National Cancer Institute has a trial that is currently recruiting:Koster et al., PMID 36251488
What would you offer as systemic therapy to an elderly woman (age >75 years) with HR negative, HER2 positive, lymph node negative breast cancer whose tumor is 2 cm or less?
The risks and benefits of adjuvant chemotherapy and anti-HER2 therapy need to be weighed. Based on lack of evidence for anti-HER2 therapy use alone in the adjuvant setting, we recommend a regimen of chemotherapy with anti-HER2 therapy - either weekly paclitaxel / trastuzumab (Tolaney, 2017) or docet...
How do you counsel patients with a curable breast cancer that there is no indication for additional surveillance imaging after treatment other than continuing annual mammograms?
This is certainly a difficult question to address. I acknowledge and validate the patient’s fears first. When breast cancer patients complete their primary therapy (often after they are stable on hormonal therapy or complete a year of Herceptin), and we begin talking about seeing them every 3 month...
How would you manage distal DVT in first trimester of pregnancy?
This is an excellent question. Essentially, this is an individual with an acute, provoked distal DVT in the setting of pregnancy. ASH 2018 guidelines for management of VTE in pregnancy recommends antithrombotic therapy with LMWH for individuals with acute VTE (Bates et al., PMID 30482767). While the...
What antibiotic, antifungal and antiviral prophylaxis you give post CAR-T therapy, and what is the duration?
This is a critical issue as more patients are being treated with CAR-T cell therapy. My approach would be as follows: Antiviral PPx: I usually consider acyclovir PPx for at least 1 year Antifungal PPx: Consider fluconazole PPx for initial neutropenia if it is prolonged beyond a week ---> once the c...