Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How do you counsel sickle cell patients on the use of G-CSF to treat neutropenia from other causes, like malignancy?
G-CSF is contraindicated in sickle cell disease. There have been many case reports of severe complications, including death in patients with SCD receiving G-CSF. I would only use it in neutropenic sepsis with transfusion support to prevent vaso-occlusive complications and after a discussion about it...
How would you approach a post-menopausal female with both a previously HR+ HER2- breast cancer and HR- HER2+ breast cancer with new brain metastasis?
The treatment of brain metastasis from breast cancer depends on a number of factors: number of metastases, biology of the cancer, status of extracranial disease, and performance status. From the question, it sounds like her performance status is good and she does not have progressive extracranial di...
Is there any role for alpelisib in a patient who has triple positive breast cancer and an activating PIK3CA mutation?
Data are limited for this indication. SOLAR-1 study (André et al., PMID 31091374) was restricted to hormone receptor positive Her2 negative patients. A phase I study of the combination of alpelisib with TDM-1 has been completed (Jain et al., PMID 29850984) and a study of alpelisib in combination wit...
Would you offer adjuvant TDM-1 to a patient with residual disease after neoadjuvant treatment for biopsy proven HER2 positive breast cancer, although residual tumor biopsy shows discordance with HER2 negative status?
Yes, I would offer T-DM1 in this case since such patients would have been included in the KATHERINE trial that showed a clear benefit in patients with residual invasive disease, unselected for repeat staining (which is not the standard of care) (1). It is plausible that the HER2 status of residual d...
Would you consider caplacizumab in a pregnant patient with iTTP?
As noted, caplacizumab was not studied in pregnancy (was an exclusion criteria) and is not approved in this setting.With that being said, as noted, caplacizumab use in pregnancy has been described in case reports (1, 2, 3) and in the post-partum setting (4). I would consider the use of caplacizumab ...
How often do you monitor AML patients after transplant for recurrence?
Assuming that your patient was transplanted in CR and there is no plan for maintenance treatment, we typically repeat BM A/Bx at D100, 6 and 12 months after alloSCT. We continue to follow PB myeloid R/D chimerism studies regularly after (q 2-3 months for the next 2 years), obviously with CBC. We do ...
How often do you monitor AML patients after transplant for recurrence?
Assuming that your patient was transplanted in CR and there is no plan for maintenance treatment, we typically repeat BM A/Bx at D100, 6 and 12 months after alloSCT. We continue to follow PB myeloid R/D chimerism studies regularly after (q 2-3 months for the next 2 years), obviously with CBC. We do ...
What would be the main indications for opting for biosimilars over an original biologic, outside of insurance barriers?
A timely question, as we head to 2023! The only reason to use biosimilars is for the broad purpose of resource stewardship. There isn't a medical reason to prefer a biosimilar over a reference product (or vice versa), because if a product were found to have a significantly different therapeutic effe...
What would be the main indications for opting for biosimilars over an original biologic, outside of insurance barriers?
A timely question, as we head to 2023! The only reason to use biosimilars is for the broad purpose of resource stewardship. There isn't a medical reason to prefer a biosimilar over a reference product (or vice versa), because if a product were found to have a significantly different therapeutic effe...
How do you incorporate surveillance imaging for patients with ovarian cancer on maintenance therapy?
I typically follow the NCCN guidelines for monitoring/follow up: Visit every 3 months for 2 years, then every 3-6 months for 3 years, then yearly after year 5. CA125 (or other tumor markers) at each visit if initially elevated (with the understanding that CA125 monitoring does not affect survival, ...