Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Would you give adjuvant chemotherapy for adenoid cystic carcinoma of breast that is low ER positive, early stage, node negative?
Simple answer: No.
What additional testing is recommended with heterozygous HFE C282Y mutation whose ferritin is elevated and transferrin saturation percentage is at baseline?
Here, both serum ferritin and transferrin saturation are significantly elevated. Assuming the patient is asymptomatic and LFTs are normal, this profile is suggestive of iron overload. I assume Hb is normal? Would do MRI to look for hepatic iron overload.
What is the appropriate management of arthralgias associated with bosutinib?
Arthralgias have been reportedly associated with the use of all TKIs. The mechanism of this adverse event is not clear. Most of them respond to management with anti-inflammatory agents. When very severe (e.g., grade 3 or 4) transient treatment interruptions and dose reductions may be indicated. In s...
What is the appropriate management of arthralgias associated with bosutinib?
Arthralgias have been reportedly associated with the use of all TKIs. The mechanism of this adverse event is not clear. Most of them respond to management with anti-inflammatory agents. When very severe (e.g., grade 3 or 4) transient treatment interruptions and dose reductions may be indicated. In s...
In patients with EGFR mutant L858R stage III NSCLC who are unresectable due to multistation N2 disease, would you consider upfront osimertinib over definitive intent CCRT?
This is a very complex question that is common among our thoracic tumor board discussions. I'll answer the latter question first. In this case, I would not offer consolidative durvalumab.There are data that immune checkpoint inhibitors (ICIs) have minimal to no benefit in the metastatic setting base...
Is there a role for neoadjuvant chemotherapy in upper-tract urothelial carcinoma?
Very common scenario with significant variability in clinical practice. There is no standard high-level evidence as compared to muscle-invasive bladder urothelial cancer, in which neoadjuvant cisplatin-based chemotherapy is the standard of care for cisplatin-eligible patients. The literature lacks d...
Would you recommend additional post-operative chemoradiation for a T2N1 proximal rectal cancer having received adjuvant capecitabine/oxaliplatin?
Pathologic T2N1 after high-quality R0 TME, in an otherwise favorable pelvic risk patient (per pre-op staging MRI) with upper rectal cancer, would not be sufficient for me to recommend post-op CRT as I don’t think there would be a clinically significant benefit that would warrant the known acute and ...
Do you recommend shingles vaccine to all immunosuppressed patients under the age of 50 y.o.?
This is an interesting question. Clearly, patients with autoimmune or immune-mediated diseases because of their immunosuppressed status are at an increased risk of H. zoster, regardless of age. Presently, the recommendations from the CDC, different professional societies, etc., are to immunize patie...
How would you approach a 2 cm malignant primary cutaneous adnexal adenocarcinoma of the axilla s/p resection with positive margin who is unable to undergo additional surgery?
I would consider imaging of the regional node basin (axilla) first. If there was evidence of regional lymph node metastasis, I would image the body to evaluate for distant metastases. If there was distant metastasis, I would probably refer for systemic therapy. If there was no distant metastasis, ...
Are there patients who can forgo anticoagulation with asymptomatic, incidentally discovered subsegmental pulmonary embolism?
Of note, there are two ongoing clinical trials that should hopefully provide further data on the definitive management of SSPE (NCT01455818, NCT04263038).