Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Should we be performing sentinel lymph node biopsies for HR+ patients ≥70 years of age?
I do not think that the monarchE data for adjuvant abemaciclib warrants changing our standard practice around omission of SLNB for patients >/= 70 yo with low-risk HR+/HER2- tumors that are clinically node-negative, because adjuvant abemaciclib is largely only appropriate for higher risk tumors and ...
What dose and fractionation would you deliver to the sole of the foot in a patient with multifocal cutaneous DLBCL that is resistant to systemic therapy?
We need some more information here. Does multifocal mean the patient has multiple skin lesions? The diagnosis of cutaneous DLBCL is also somewhat ambiguous. Is this cutaneous DLBCL leg type, a specific entity in the WHO pathology classification, or perhaps the older WHO classification is being used ...
Is it acceptable to use TCHP instead of AC-T + trastuzumab as neoadjuvant chemotherapy for HER2+ inflammatory breast cancer?
Yes. With the Neosphere trial demonstrating an impressive PCR rate for the TCHP regimen, the TRAIN-2 trial showing no difference in outcomes with anthracycline containing vs non-anthracycline regimen and the BCIRG-006 trial long term follow showing that only 7 DFS events separating AC-TH and TCH, I ...
What are your top takeaways in GI Cancers from ESMO 2024?
Re: the IMbrave050 trial: It was perhaps not unexpected, but still disappointing, to see the trial did not meet its primary endpoint of improvement in RFS. It would be interesting to see if there is a signal in preventing late recurrences, as we know there are two groups of patients: those that rec...
Do you recommend concurrent cisplatin and gemcitabine with radiotherapy for unresectable vulvar cancer, as described in GOG-279?
We are still doing weekly cisplatinum with a higher dose of RT as there is concern about additional morbidity with the addition of gemzar. Richman et al., PMID 32981696
What is the utility of granulocyte infusions in patients with neutropenia and severe infection?
Granulocyte transfusion is infrequently used for septic neutropenic patients given that the randomized trial (RING) that looked at this question did not show improved outcomes (with the caveat that the trial did not finish accrual (Price et al., PMID 26333778). Having said that, the criteria to cons...
How do you differentiate atopic dermatitis from mycosis fungoides histologically?
Differentiating mycosis fungoides from any spongiotic process (atopic dermatitis, allergic contact dermatitis, etc.) is extremely difficult and typically requires correlation with clinical features and sometimes molecular findings. Some features that favor mycosis fungoides are: Lymphocytic exocyto...
When do you recommend endocrine therapy for chemoprevention in women with high-risk benign breast lesions?
Women with atypical hyperplasia or lobular carcinoma in situ have a 4-10 fold increase in breast cancer risk. In the randomized controlled trials of endocrine therapy for chemoprevention for 5 years, this subset of women with high-risk benign breast lesions had up to a 60-70% relative risk reduction...
What is your practice regarding giving G-CSF to patients with ALL during initial induction?
My colleagues and I do not use G-CSF in either ALL or AML unless the neutropenia is unusual and prolonged and associated with infection. The use of G-CSF has been shown to shorten neutropenia by a few days but does not prevent the drop and theoretically, at least it may prolong thrombocytopenia by p...
What is your practice regarding giving G-CSF to patients with ALL during initial induction?
My colleagues and I do not use G-CSF in either ALL or AML unless the neutropenia is unusual and prolonged and associated with infection. The use of G-CSF has been shown to shorten neutropenia by a few days but does not prevent the drop and theoretically, at least it may prolong thrombocytopenia by p...