Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
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...
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...
Would you consider splenic radiation in stage IV CD5+ DLBCL involving the bone marrow in patients who initially presented with symptomatic splenomegaly, anemia, and thrombocytopenia but achieved complete response on PET after 6 cycles of R-miniCHOP?
CD5 positivity is an adverse prognostic factor in DLBCL. About 5% of patients with DLBCL are CD5+. Other adverse risk factors are often present in these patients (advanced age, non-germinal center histology, high IPI, etc.). More generally speaking, the role of consolidation RT in advanced DLBCL is ...
Is there data to suggest that definitive chemoradiation to 70Gy vs. postoperative chemoradiation to 60 or 66Gy has any different clinically significant effects on long term swallowing function and other side effects of H&N cancer treatment?
There are no good comparisons. The surgical literature that focuses on TLM/TORS tries to make this claim, but if you look at modern IMRT series, G-tube rates are equivalent, and are in part dependent on T_stage, since a T4 pt is more likely than a T1 pt to get chronic dysphagia. There are also no co...
For early stage indolent NHL (low grade follicular, MALT) involving midline structures of the head and neck (ie base of tongue, soft palate) how do you apply the concepts of ISRT?
@Dr. First Last,I think your question is a good one and probably not one answerable by definitive data. However, the recent publication of the ILROG guidelines on extranodal disease (Yahalom et al, https://www.ncbi.nlm.nih.gov/pubmed/25863750) and bulk of available data I believe suggest that it’s o...
In a patient with early stage HER2+ breast cancer s/p surgery, would you consider a noncytotoxic chemotherapy approach with anti-Her2 therapy alone if the PS is borderline and/or patient declines chemotherapy?
We now have evidence from several prospective clinical trials enrolling elderly patients and patients who were not fit to receive chemotherapy demonstrating that single agent adjuvant trastuzumab treatment is active and offers a reasonable treatment option without any significant risk of cardiac tox...
In what situations would a standard FDG PET/CT be useful in the evaluation of high risk prostate cancer?
Overall, my impression is that the use of FDG PET for this purpose is limited. If interested, below is my rationale as summarized in the Conclusion.As mentioned, PSMA PET/CT is considered by many to be the current best standard of care for the staging evaluation of high-risk prostate cancer, and it ...
Would you consider a patient with DLBCL to have CNS involvement if no brain lesion is seen on imaging, CSF flow cytometry is negative, but PCR is positive for MYD88 and KMT2D mutations?
Cerebrospinal fluid (CSF) is an ultrafiltrate of plasma contained within the ventricles of the brain and the subarachnoid spaces of the cranium and spine. It is possible that cfDNA fragments containing MYD88 and KMT2D mutations may have found their way into the CSF and thereby detected by PCR techni...
What is the recommended approach for systemic therapy for patients with locally recurrent p16-positive SCC of the oral cavity who are not candidates for resection or re-irradiation?
The recommended regimen would depend on the PD-L1 (CPS) score and would be guided by recent clinical trials, particularly KEYNOTE-048 and KEYNOTE-B10.The KEYNOTE-048 trial has established pembrolizumab as a preferred first-line treatment option. While monotherapy for CPS-positive patients could be c...