Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Do you routinely continue patients on anti-PD(L)-1 beyond 2 years of treatment while on IO/TKI for metastatic ccRCC?
I routinely continue anti-PD(L)-1 beyond 2 years while on IO/TKI for patients with clear cell RCC. Of course, this is assuming the patient is tolerating therapy well, continues to be with stable disease/response, and prefers continuation of therapy. I do have a discussion with them at the 2-year mar...
What is your approach to treatment of relapsed, high-risk MDS with TP53 mutation in a patient that is not considered a transplant candidate?
I don't think that there is a particular answer for those with TP53 mutation with the exception of poor prognosis with whatever will be offered to them. I suggest azacitidine-based therapy based on improved overall survival (OS) compared with other approaches. Azacitidine is the treatment of choice ...
What is your approach to treatment of relapsed, high-risk MDS with TP53 mutation in a patient that is not considered a transplant candidate?
I don't think that there is a particular answer for those with TP53 mutation with the exception of poor prognosis with whatever will be offered to them. I suggest azacitidine-based therapy based on improved overall survival (OS) compared with other approaches. Azacitidine is the treatment of choice ...
What are your next steps for managing biopsy-proven interstitial nephritis from checkpoint inhibitors in patients who do not have a response to prednisone?
As indicated by Dr. @Dr. First Last, based on their publication, if there is biopsy-proven evidence for AIN with no evidence of concurrent GN or vasculitis, then a trial of infliximab is reasonable. Our experience at our institution is that the creatinine increases if the prednisone is tapered too q...
How do you counsel an early stage breast cancer patient with lupus regarding decisions on radiation?
The data with lupus and RT is not consistent and most recent data suggest good tolerance to breast RT. I have them continue on medication for lupus and counsel them that acute morbidity and late effects appear to similar although there is some chance it may be enhanced but not contraindication to RT...
How would you approach an elderly patient with early stage TNBC with node negative disease?
While patient age, comorbidities, and T stage could influence my recommendations, if I felt that the patient was in good enough shape to tolerate chemotherapy and that her risk of distant recurrence was high enough to warrant treatment (relative to her life expectancy), I would favor administering w...
Would you use neoadjuvant TKI or neoadjuvant radiation for a large chest wall sarcoma with an NTRK fusion on NGS?
Although there is no data to support the "neoadjuvant" use of NTRK inhibitors in NTRK-fused sarcomas, the rapidity of response to this approach is amazing. There is also a school of thought that the use of NTRK inhibitors in NTRK-fused sarcomas affords a durable response. My experience is different....
Is there any role for radiation in the treatment of stage II nasopharyngeal DLBCL involving bilateral nasopharynx and unilateral cervical nodal involvement but without bony or nerve involvement?
The role of RT in the rx of stage II DLBCL, either nodal or extranodal in type, remains controversial with NCCN guidelines allowing for either approach. There is agreement that initial therapy should be systemic, typically R-CHOP at present. For patients achieving CR (PET-negative), we routinely use...
Does HPV-status play a role in selection of immune checkpoint inhibitors in upfront treatment of metastatic head and neck cancer?
In my practice, HPV-status in isolation does not play a role in selection of immune checkpoint inhibitors in initial treatment of recurrent/metastatic head/neck squamous cell cancer (R/M HNSCC). The current FDA approval for first-line management of R/M HNSCC is for pembrolizumab in combination with ...
How often do you monitor for pancreatitis (check lipase/amylase) while on Axitinib?
I don't routinely measure amylase/lipase on axitinib or other TKIs. In the early days of sunitinib development, lipase was measured and often elevated without clinical symptoms. This led to unnecessary other labs and anxiety. I have a low threshold to measure in the right clinical context, but frank...