Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
In patients with cholangiocarcinoma who qualify for HAIP therapy, would you recommend treating with chemotherapy and immunotherapy?
Thank you for the question. I agree that the HAIP can be an effective option for carefully selected patients ineligible for resection in the hands of experts experienced with HAIP- and has offered improvements in PFS & OS. However, to date, published data has only been in combination with cytotoxic ...
What is the recommended initial treatment for spinal cord compression due to non-Hodgkin lymphoma (e.g. diffuse large B-cell lymphoma)?
The answer depends greatly on clinical circumstances, such as stage of disease, degree of neurological impairment, prior treatment if any, etc. First, I would argue there is seldom a role for surgical intervention ( other then biopsy to establish diagnosis) since lymphomas are uniquely radiosensitiv...
What is your approach to treatment of infection-triggered HLH that does not respond to treatment of the underlying infection?
The algorithm our center follows is to Recognize hyperinflammation (see answer to question above -- in addition to baseline labs, we obtain an infectious disease consult) Look for and treat the trigger. A concern, if the patient is responding, is that we are missing a trigger (HLH does not occur sp...
Do you use the same criteria for offering neoadjuvant chemotherapy in a lobular breast cancer as you would in ductal?
HER2+ ILC is uncommon but can be seen in about 5% of ILC cancer cases. A retrospective review by MD Anderson suggested similar outcomes for HER2+ ILC vs IDC. (JCO 2012, ASCO Absract 612) I would confirm the HER2+ and low grade in this case, as that is discordant. As for regular ILC which is usually ...
Would you anticoagulate an SMV thrombosis caused by malignant obstruction in the setting of metastatic colorectal cancer?
Superior Mesenteric Vein Thrombosis is a rare phenomenon, within the category of Splanchnic thrombosis. While portal vein thrombosis is most often associated with cirrhosis (though also seen in many patients without cirrhosis), SMV thrombosis is more commonly seen in the context of either local prov...
Would you anticoagulate an SMV thrombosis caused by malignant obstruction in the setting of metastatic colorectal cancer?
Superior Mesenteric Vein Thrombosis is a rare phenomenon, within the category of Splanchnic thrombosis. While portal vein thrombosis is most often associated with cirrhosis (though also seen in many patients without cirrhosis), SMV thrombosis is more commonly seen in the context of either local prov...
Is there a concern for the potential of future congenital malformations in offspring when preservation of eggs and sperm is done AFTER cyclophosphamide treatment given that it is an alkylating agent?
No, there is not a significant risk of congenital malformations in embryos created with cryopreserved gametes or unassisted pregnancies AFTER cyclophosphamide use. While alkylating agents lead to both male and female infertility, congenital malformations from cyclophosphamide occur when conception h...
How would you approach a patient with symptomatic anal cancer and oligometastatic lesion to the lung?
Systemic treatment is the standard approach for metastatic anal squamous cell cancer. Carboplatin plus paclitaxel or 5FU plus cisplatin are reasonable choices. Recently, the InterAACT trial (Rao et al. JCO 2020) involving 91 patients comparing carboplatin/paclitaxel to 5FU/cisplatin showed similar O...
How would you work up a patient with prostate cancer with bone scan suspicious for metastatic disease and a negative PSMA PET/CT?
While some bone metastases are 99mTc-positive and PSMA-negative, this circumstance is quite rare (< 2%). Based on this alone, in cases like this, I typically conclude that the patient is clinically M0. However, I do consider 3 other factors: the prevalence of bone metastases within the patient’s par...
Does mucinous histology impact your recommendations for neoadjuvant therapy in a postmenopausal patient with HR+ HER2- breast cancer with multiple positive lymph nodes?
My preference in this case (if the patient is resectable) is to do surgery first. This allows confirmation if it is mixed vs pure mucinous on the resected tumor plus pathologic node staging. Not much to be gained by neoadjuvant therapy except if she needs it to attempt surgery. Pure mucinous tumors ...