Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How do you approach patients with SMARCB1 deficient sinonasal carcinoma for immunotherapy?
Sinonasal cancers that are SMARCB1-deficient are rare. They tend to be more aggressive, present in more advanced stages, and tend to be associated with non-keratinizing histology. Despite this, there are no guidelines for a differential approach for these tumors and they are treated in a similar fas...
How do you approach treatment for patients with proliferative glomerulonephritis with monoclonal IgG deposits (PGNMID) with end-stage renal disease who are considering kidney transplant?
Monoclonal gammopathy of renal significance includes a variety of renal pathologies: MIDD (LCDD, LHCDD, HCDD). Monoclonal immunotactoid glomerulonephritis or type 1 cryoglobulinemic glomerulonephritis. Light chain proximal tubulopathy or crystal-storing histiocytosis. C3 glomerulopathy with monoclon...
Would you ever consider repeating chemoradiation for patients with locally recurrent small cell lung cancer after prior chemoradiation for LS-SCLC?
I have re-treated in-field local recurrence SCLC advising thoracic radiotherapy first using SBRT dose and technique. Also, new lung cancers are more common in those who could not stop smoking.
When will you consider doing a biopsy of a potential metastatic site (lymph node, lung/visceral) for testicular cancer after orchiectomy?
I will biopsy a potential metastatic deposit seen on the scan after the orchiectomy if tumor markers are negative, have reduced to normal with appropriate half-lives, or are equivocal. A raised LDH, in isolation, is not enough to support the diagnosis of metastasis, and I will usually biopsy if that...
How do you approach immunosuppression in patients with a positive Interferon Gamma Release Assay and prior intravesicular BCG treatment for bladder cancer?
Bacillus Calmette–Guérin (BCG) is the most widely used vaccine worldwide and has been used to prevent tuberculosis for a century. BCG also stimulates an anti-tumor immune response, which urologists have harnessed for the treatment of non-muscle-invasive bladder cancer. As rheumatologists, we occasio...
How do you approach the management of resected Stage IIA adenocarcinoma of the colon in an elderly but highly functional patient?
How would you treat a stage IIIB recurrent seminoma with early recurrence following first-line treatment with VIP?
If one is faced with recurrent stage IIIB seminoma, I recommend the following: Confirm the diagnosis and prior Rx - review initial pathology, staging, and dose/ intensity of Rx. Sometimes, another clinician has treated the wrong entity - where review shows that it was initially a nonseminomatous ge...
How would you treat a recurrent seminoma after 1st line BEP, now growing during salvage TIP despite initial response?
If this is truly growing seminoma, he is now platinum refractory and the ONLY chemotherapy option that would have a chance for cure would be to go straight to high dose carboplatin + etoposide with peripheral blood stem cell transplant. He also is not curable with radiation therapy. If his serum hCG...
How do you assess whether an early-stage Hodgkin's patient is unfavorable?
I personally utilize the GHSG criteria for most patients. To review, a patient has "favorable" disease if they meet all of the following criteria: 1. 1-2 involved sites 2. No bulky disease 3. No extranodal disease (which is rare in early-stage HL) 4. Favorable ESR/B-symptoms profile (ESR < 30 with B...