Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
For pre-menopausal patients with high-risk ER+ disease, and who desire pregnancy, what is the best time frame to pause endocrine therapy to allow for pregnancy?
Evidence suggests that pregnancy after a breast cancer diagnosis, even among women with hormone positive tumors, does not increase the risk of recurrence, however this has not been prospectively studied. Current guidelines suggest waiting 2 years, however this is based on retrospective data, that is...
Do you offer memantine for patients undergoing PCI?
Extrapalating on 0614, I do use memantine for patients undergoing PCI. I do this for 6 months. These are patients that are expected to live even longer than brain met patients. And given the low toxicity, I think it would be rude not too (as one of my former students would say!)
When would you recommend adjuvant radiation therapy for a patient with a completely resected (negative margins) dermatofibrosarcoma protuberans?
Agree, we usually do not. Especially if these patients are completely cleared with Mohs surgery, which is found to have lower recurrence rates than WLE.
How do you manage hemophilia A carriers with no history of bleeding complications but with mildly low factor VIII activity (6-40%)?
This is a wide range, if no history of bleeding then do not need factor on a regular basis. But for invasive procedures/surgery/trauma depending on what their levels are at baseline and the bleeding risk of the procedure, you will need to use factor 8, antifibrinolytic agents, or DDAVP. Same about t...
When would you consider using G-CSF in patients with rheumatic disease who have received cyclophosphamide?
Our primary concern would be our patients with systemic lupus erythematosus. There are reports of severe flares in SLE patients treated with G-CSF (vasculitis and nephritis; Vasiliu et al, PMID 16832843) and even reports of cardiac arrest (Ragsdale & Hall Zimmerman, PMID 34748466).Of course, this ne...
Will prior novel hormonal therapy affect when/how you use olaparib plus abiraterone for patients with BRCA-mutated metastatic castration resistant prostate cancer?
Yes, there is no clear data at this time that an AR/PARP inhibitor combination prolongs rPFS or OS in men with mCRPC who have progressed on a prior potent AR inhibitor, as largely these men were excluded or not included in PROpel, MAGNITUDE, or TALAPRO-2. For patients who develop mCRPC but have not ...
Would you offer adjuvant immunotherapy in an elderly patient with stage IIB desmoplastic melanoma post resection with underlying autoimmune disease?
As discussed with our desmoplastic melanoma expert at The Ohio State University, Kari L. Kendra, MD - "Because some patients are potentially "cured" with surgical resection alone and this patient has an autoimmune disease, would not treat in the adjuvant setting. If there is local recurrence, would ...
In a patient with local recurrence of breast cancer after mastectomy, how would you sequence adjuvant treatment after wide local resection?
Endocrine therapy can be given simultaneously with RT without increasing toxicity or decreasing effectiveness, as shown in a randomized French-Swiss trial (Azria et al., PMID 20138810). Toxicities from chemotherapy may be greater and its effectiveness reduced (at least for high-risk patients) when g...
Do you consider using 160 mg osimertinib in patients with EGFR-positive metastatic NSCLC to the brain?
The BLOOM study [Yang et al., PMID 31809241] was the first to address the question of CNS dosage for patients with EGFR mutant NSCLC with brain metastases. In this, patients with cytologically confirmed leptomeningeal (LM) disease received osimertinib 160 mg once daily. LM disease was assessed by bl...
Do you recommend neoadjuvant chemotherapy or induction chemo + chemoRT for borderline resectable pancreatic cancer?
The definition of BRPC has expanded to include everything from minimal venous involvement to 180 degree abutment of the SMA. It is important to determine if there is arterial involvement. If there is, the best data show that XRT helps with R0 resections. In our experience at MDACC, 95% of patients w...