Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How do you differentiate atopic dermatitis from mycosis fungoides histologically?
Differentiating mycosis fungoides from any spongiotic process (atopic dermatitis, allergic contact dermatitis, etc.) is extremely difficult and typically requires correlation with clinical features and sometimes molecular findings. Some features that favor mycosis fungoides are: Lymphocytic exocyto...
When do you recommend endocrine therapy for chemoprevention in women with high-risk benign breast lesions?
Women with atypical hyperplasia or lobular carcinoma in situ have a 4-10 fold increase in breast cancer risk. In the randomized controlled trials of endocrine therapy for chemoprevention for 5 years, this subset of women with high-risk benign breast lesions had up to a 60-70% relative risk reduction...
What is your practice regarding giving G-CSF to patients with ALL during initial induction?
My colleagues and I do not use G-CSF in either ALL or AML unless the neutropenia is unusual and prolonged and associated with infection. The use of G-CSF has been shown to shorten neutropenia by a few days but does not prevent the drop and theoretically, at least it may prolong thrombocytopenia by p...
What is your practice regarding giving G-CSF to patients with ALL during initial induction?
My colleagues and I do not use G-CSF in either ALL or AML unless the neutropenia is unusual and prolonged and associated with infection. The use of G-CSF has been shown to shorten neutropenia by a few days but does not prevent the drop and theoretically, at least it may prolong thrombocytopenia by p...
Do you routinely continue patients on anti-PD(L)-1 beyond 2 years of treatment while on IO/TKI for metastatic ccRCC?
I routinely continue anti-PD(L)-1 beyond 2 years while on IO/TKI for patients with clear cell RCC. Of course, this is assuming the patient is tolerating therapy well, continues to be with stable disease/response, and prefers continuation of therapy. I do have a discussion with them at the 2-year mar...
What is your approach to treatment of relapsed, high-risk MDS with TP53 mutation in a patient that is not considered a transplant candidate?
I don't think that there is a particular answer for those with TP53 mutation with the exception of poor prognosis with whatever will be offered to them. I suggest azacitidine-based therapy based on improved overall survival (OS) compared with other approaches. Azacitidine is the treatment of choice ...
What is your approach to treatment of relapsed, high-risk MDS with TP53 mutation in a patient that is not considered a transplant candidate?
I don't think that there is a particular answer for those with TP53 mutation with the exception of poor prognosis with whatever will be offered to them. I suggest azacitidine-based therapy based on improved overall survival (OS) compared with other approaches. Azacitidine is the treatment of choice ...
What are your next steps for managing biopsy-proven interstitial nephritis from checkpoint inhibitors in patients who do not have a response to prednisone?
As indicated by Dr. @Dr. First Last, based on their publication, if there is biopsy-proven evidence for AIN with no evidence of concurrent GN or vasculitis, then a trial of infliximab is reasonable. Our experience at our institution is that the creatinine increases if the prednisone is tapered too q...
How do you counsel an early stage breast cancer patient with lupus regarding decisions on radiation?
The data with lupus and RT is not consistent and most recent data suggest good tolerance to breast RT. I have them continue on medication for lupus and counsel them that acute morbidity and late effects appear to similar although there is some chance it may be enhanced but not contraindication to RT...
How would you approach an elderly patient with early stage TNBC with node negative disease?
While patient age, comorbidities, and T stage could influence my recommendations, if I felt that the patient was in good enough shape to tolerate chemotherapy and that her risk of distant recurrence was high enough to warrant treatment (relative to her life expectancy), I would favor administering w...