Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Do you recommend routine use of Evusheld for pre-exposure prophylaxis for patients on immunosuppression?
The use of monoclonal antibodies as passive immunity for pre-exposure prophylaxis is an exciting development for vulnerable patients, including immunosuppressed patients (either primary or through medications such as for autoimmune diseases), cancer patients, and organ transplant recipients. Evushel...
Do you recommend routine use of Evusheld for pre-exposure prophylaxis for patients on immunosuppression?
The use of monoclonal antibodies as passive immunity for pre-exposure prophylaxis is an exciting development for vulnerable patients, including immunosuppressed patients (either primary or through medications such as for autoimmune diseases), cancer patients, and organ transplant recipients. Evushel...
Does the degree of elevation in free light chains/ratio correlate with a probability of AL amyloidosis?
YES, the difference between the kappa and lambda free light chains (dFLC) correlates with the probability of a diagnosis of AL amyloidosis. A significant dFLC indicates a higher likelihood of the disease and can also provide some moderately valuable prognostic information.But NO, I have not seen dat...
Does the degree of elevation in free light chains/ratio correlate with a probability of AL amyloidosis?
YES, the difference between the kappa and lambda free light chains (dFLC) correlates with the probability of a diagnosis of AL amyloidosis. A significant dFLC indicates a higher likelihood of the disease and can also provide some moderately valuable prognostic information.But NO, I have not seen dat...
How do you manage colorectal tumors that have components in the colon and rectum on MRI?
For a tumor straddling the peritoneal reflection, it is only the rectal component that would make one consider RT. The reason for a local recurrence of rectal cancer is residual disease from the primary tumor either at the margin of resection of the primary tumor or from residual lymph nodes in the ...
Would you treat a completely resected Stage IA NSCLC EGFR exon 19 with adjuvant osimertinib alone omitting chemotherapy?
How would you treat a residual mediastinal mass in patients with a mediastinal germ cell tumor with an incomplete response to primary chemotherapy with BEPx4?
Several comments:1. VIP is preferred over BEP for PMNSGCT if there will be consideration for extensive mediastinal resection (JCO 34:4445,2016)2. Patient should be evaluated at a center with experienced and skilled thoracic surgical oncology to determine if patient is truly inoperable.3. Need more i...
For patients with rectal cancer being treated along PROSPECT paradigm, would you extrapolate from the IDEA literature and offer 3 months of CAPOX neoadjuvantly, without adjuvant therapy?
I would! I did it in a recent patient.
Does ctDNA play a “surveillance” role in advanced biliary tract cancers during active therapy assessing response and/or defining relapsing disease?
I do not routinely measure ctDNA in biliary tract cancers to assess response (I do use tumor markers and a good cross-sectional imaging modality such as CT or MRI, however). The investigators on the TOPAZ-1 study have published their work with ctDNA and it does correlate with responders but it is un...
What is your preferred approach to a patient with myeloma who has refractory disease to Dara-VRd in the frontline setting?
Unless the patient is not actually receiving some or all of the Dara-RVd (lenalidomide compliance can be challenging), this functionally defines high risk disease. Most patients don't usually have disease stability for autologous transplant, or even if they are stable for a hot second, transplant pr...