Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How do you manage MPN patients with acquired VWD in the perioperative setting?
The greatest risk of a very high platelet is bleeding not thrombosis, and it is fair to say that this appears to apply to myeloproliferative (MPN) thrombocytosis as opposed to reactive thrombocytosis (there is no correlation between the platelet count and thrombosis with either cause of thrombocytos...
What is your first line treatment for progressive well differentiated metastatic (and unresectable) pancreatic neuroendocrine tumors?
I assume you mean by (Progressive) metastatic pNETs, patients who are already progressed on SSAs. There are many points to consider in these patients: Grade: Are we talking about G1/2 vs G3 NET? This will affect our decision and how aggressive we should be. Are the met lesions exclusively hepatic v...
How would you treat a widely metastatic poorly differentiated pancreatic neuroendocrine cancer?
The standard first line systemic therapy for poorly differentiated extrapulmonary neuroendocrine carcinoma (EP NEC) remains PE or platinum and etoposide (with some studies suggesting superiority of cis over carbo which likely reflects bias from patient characteristics). This is based on less than op...
Which targeted systemic agents should be held while delivering palliative radiation?
Great question regarding the use of systemic therapy for cancer during palliative radiation. First, regarding targeted therapies, there are no reports of targeted therapies which would be unsafe or should be held during palliative radiotherapy. Most targeted agents are monoclonal antibodies to recep...
What is the preferred second line agent for a woman with metastatic vulvar cancer who has progressed on carboplatin/paclitaxel?
There is not one preferred second line agent for women with metastatic vulvar cancer who have progressed on carboplatin/paclitaxel. My preference is to put those patients on clinical trial, if possible. Next generation sequencing of the tumor could guide placement into a trial (such as MATCH or TAPU...
Would you go back and do an axillary lymph node dissection if a sentinel lymph node biopsy showed a single lymph node with extracapsular extension?
For microscopic ECE, would manage with comprehensive RNI but if gross ECE, would favor dissection and then RT.
Would you recommend axillary dissection for a patient with cT1N1 triple negative metaplastic breast cancer?
Although these cancers are underrepresented in SNLN and RT studies, we treat with the same principle like any other breast cancer with SNLN bx. Gebhardt et al., PMID 30197938
Did the approval of lutetium Lu 177 vipivotide tetraxetan (Pluvicto) change how you image and manage patients with metastatic castrate-resistant prostate cancer?
The FDA approval of Pluvicto was a welcome addition to a growing list of treatments for patients with mCRPC. Logistical issues with administration have slowed the routine implementation of this therapy in the US. In terms of imaging, a PSMA-PET is required prior to the administration of Pluvicto to ...
What is the best management for a patient with advanced renal medullary carcinoma?
Very interesting regarding case reports of long term responses with proteasome inhibitors. Thanks for sharing.
Can defibrotide be given safely for VOD in patients with refractory thrombocytopenia to platelet transfusions?
The short answer is "yes."The slightly longer answer is: “Yes, and in patients with veno-occlusive disease (VOD), the use of defibrotide is potentially life-saving (Richardson et al., PMID 26825712).” In the cited study, which led to its FDA approval for this indication, there was no significant dif...