Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
For patients with metastatic poorly differentiated large cell neuroendocrine carcinoma of the lung, do you typically use NSCLC or SCLC regimens?
Earlier Studies have shown controversial results. Some show that small cell lung cancer-based regimen concluded better outcome; however, more recently, gemcitabine-platinum therapy in specific and NSCLC-based regimens led to a better outcome.We reported a retrospective study showing no statistically...
How would you treat an elderly male with history of mantle cell lymphoma who relapsed after chemoimmunotherapy and cBTKi w/ multiple co-morbidities including CKD and CHF w/ low EF?
There's obviously a lot of additional information that would help in making individual patient-level recommendations here. What was the first line of chemoimmunotherapy, and how was it tolerated? How long was his duration of response? How was the response to covalent BTKi in depth and duration? What...
How would you treat an elderly male with history of mantle cell lymphoma who relapsed after chemoimmunotherapy and cBTKi w/ multiple co-morbidities including CKD and CHF w/ low EF?
There's obviously a lot of additional information that would help in making individual patient-level recommendations here. What was the first line of chemoimmunotherapy, and how was it tolerated? How long was his duration of response? How was the response to covalent BTKi in depth and duration? What...
Based on the VESPER trial data, do you recommend the full 6 cycles or 3-4 cycles of ddMVAC for neoadjuvant muscle invasive bladder cancer treatment?
For clinically node negative MIBC: I give 4 cycles of neoadjuvant chemotherapy either (preferably) dose dense MVAC with G-CSF or Gemzar/Cisplatin. For cN+ MIBC: I tend to restage after 3 cycles and consider up to 6 cycles for patients who can tolerate induction chemo and do not have interim progress...
Based on the ASC4MORE trial, would you add asciminib to imatinib if patients do not achieve deep molecular remission at 1-year?
This is hard to justify. If you are using asciminib, the patient likely has had resistance to several prior TKI's. In this setting, treatment discontinuation is not recommended outside of clinical trials. Achieving BCR::ABL1 <=1% is an adequate response likely to improve survival, and about 40% of p...
Based on the ASC4MORE trial, would you add asciminib to imatinib if patients do not achieve deep molecular remission at 1-year?
This is hard to justify. If you are using asciminib, the patient likely has had resistance to several prior TKI's. In this setting, treatment discontinuation is not recommended outside of clinical trials. Achieving BCR::ABL1 <=1% is an adequate response likely to improve survival, and about 40% of p...
Are SCDs contraindicated in patients with acute DVTs?
SCDs can help prevent DVT but I'm not aware of any evidence of benefit when treating an established event. There are rare reports of pulmonary embolism following the application of SCDs in patients with asymptomatic DVTs. I don't think this constitutes an absolute contraindication, but in the absenc...
How would you manage a patient with SLE that has a remote history of positive anti-phospholipid antibodies with a current DVT and now completely negative APLs?
Assuming the reliability of the lab report indicating negative antiphospholipid antibodies (APL) and the absence of any other manifestations as per the latest APLS guidelines, I generally would not factor a distant history of APL positivity when determining the management of this patient.While the f...
How do you approach anti-seizure medication management when it was started by another team for a seizure-naive patient before/after craniotomy for a tumor?
I would refer you to Dr. @Dr. First Last's answer to a similar question (https://www.themednet.org/question/15031) which beautifully summarizes data and guidelines. I usually counsel patients that everyone regardless of their medical history has a certain risk of seizure under physical stressors, th...
What is your treatment approach for a patient with metastatic hepatocellular carcinoma with Child's Pugh B cirrhosis?
Child Pugh B cirrhosis is a spectrum of disease, and requires careful consideration of the underlying cause of the cirrhosis as well as the potential impact of cancer therapy. As @Dr. First Last pointed out, there is data for sorafenib in this patient population, demonstrating a similar relative ben...