Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
What chemotherapy, if any, would you offer for an elderly patient with congestive heart failure with completely excised Stage I classical Hodgkin lymphoma?
Radiation is a curative option here.
What chemotherapy, if any, would you offer for an elderly patient with congestive heart failure with completely excised Stage I classical Hodgkin lymphoma?
Radiation is a curative option here.
Would you include the entire hardware as part of ISRT for a patient with Stage IE DLBCL of the distal femur treated with upfront prophylactic nailing for impending fracture, who had a CR to chemotherapy?
Quite uncommon to encounter such a patient, but based on data for non hematologic tumors, no. Treat just the involved site with a generous margin, the latter never precisely defined, but depends on the tolerance of surrounding normal tissue. Parenthetically, it's often difficult to determine a CR to...
What dose and fractionation do you use to palliate mycosis fungoides lesions?
I will admit that I utilize a wide range of fractionation schedules, depending on the clinical circumstances when treating mycosis fungoides. The data suggests that 2 Gy x2 is not an effective palliative schedule, with a CR rate of only ~30% with almost all lesions requiring re-treatment (Neelis et ...
For patients with resected pancreatic cancer who received neoadjuvant gemcitabine + Abraxane, would you switch to gemcitabine + capecitabine to complete 6 months of peri-operative therapy?
I would only administer neoadjuvant gem + Abraxane in very rare circumstances. If, for example, I have already tried mFFX and it did not achieve the response needed to get a borderline tumor to resectability. In that case, it would be tempting to use G+A as adjuvant therapy, but I would still strong...
How do you manage MPN patients with acquired VWD in the perioperative setting?
The greatest risk of a very high platelet is bleeding not thrombosis, and it is fair to say that this appears to apply to myeloproliferative (MPN) thrombocytosis as opposed to reactive thrombocytosis (there is no correlation between the platelet count and thrombosis with either cause of thrombocytos...
How do you manage MPN patients with acquired VWD in the perioperative setting?
The greatest risk of a very high platelet is bleeding not thrombosis, and it is fair to say that this appears to apply to myeloproliferative (MPN) thrombocytosis as opposed to reactive thrombocytosis (there is no correlation between the platelet count and thrombosis with either cause of thrombocytos...
What is your first line treatment for progressive well differentiated metastatic (and unresectable) pancreatic neuroendocrine tumors?
I assume you mean by (Progressive) metastatic pNETs, patients who are already progressed on SSAs. There are many points to consider in these patients: Grade: Are we talking about G1/2 vs G3 NET? This will affect our decision and how aggressive we should be. Are the met lesions exclusively hepatic v...
How would you treat a widely metastatic poorly differentiated pancreatic neuroendocrine cancer?
The standard first line systemic therapy for poorly differentiated extrapulmonary neuroendocrine carcinoma (EP NEC) remains PE or platinum and etoposide (with some studies suggesting superiority of cis over carbo which likely reflects bias from patient characteristics). This is based on less than op...
Which targeted systemic agents should be held while delivering palliative radiation?
Great question regarding the use of systemic therapy for cancer during palliative radiation. First, regarding targeted therapies, there are no reports of targeted therapies which would be unsafe or should be held during palliative radiotherapy. Most targeted agents are monoclonal antibodies to recep...