Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How would you treat a stage IIIB recurrent seminoma with early recurrence following first-line treatment with VIP?
If one is faced with recurrent stage IIIB seminoma, I recommend the following: Confirm the diagnosis and prior Rx - review initial pathology, staging, and dose/ intensity of Rx. Sometimes, another clinician has treated the wrong entity - where review shows that it was initially a nonseminomatous ge...
How would you treat a recurrent seminoma after 1st line BEP, now growing during salvage TIP despite initial response?
If this is truly growing seminoma, he is now platinum refractory and the ONLY chemotherapy option that would have a chance for cure would be to go straight to high dose carboplatin + etoposide with peripheral blood stem cell transplant. He also is not curable with radiation therapy. If his serum hCG...
How do you assess whether an early-stage Hodgkin's patient is unfavorable?
I personally utilize the GHSG criteria for most patients. To review, a patient has "favorable" disease if they meet all of the following criteria: 1. 1-2 involved sites 2. No bulky disease 3. No extranodal disease (which is rare in early-stage HL) 4. Favorable ESR/B-symptoms profile (ESR < 30 with B...
How do you treat muscle invasive bladder cancer with neuroendocrine differentiation?
Would you give adjuvant chemotherapy for adenoid cystic carcinoma of breast that is low ER positive, early stage, node negative?
Simple answer: No.
What additional testing is recommended with heterozygous HFE C282Y mutation whose ferritin is elevated and transferrin saturation percentage is at baseline?
Here, both serum ferritin and transferrin saturation are significantly elevated. Assuming the patient is asymptomatic and LFTs are normal, this profile is suggestive of iron overload. I assume Hb is normal? Would do MRI to look for hepatic iron overload.
What is the appropriate management of arthralgias associated with bosutinib?
Arthralgias have been reportedly associated with the use of all TKIs. The mechanism of this adverse event is not clear. Most of them respond to management with anti-inflammatory agents. When very severe (e.g., grade 3 or 4) transient treatment interruptions and dose reductions may be indicated. In s...
What is the appropriate management of arthralgias associated with bosutinib?
Arthralgias have been reportedly associated with the use of all TKIs. The mechanism of this adverse event is not clear. Most of them respond to management with anti-inflammatory agents. When very severe (e.g., grade 3 or 4) transient treatment interruptions and dose reductions may be indicated. In s...
In patients with EGFR mutant L858R stage III NSCLC who are unresectable due to multistation N2 disease, would you consider upfront osimertinib over definitive intent CCRT?
This is a very complex question that is common among our thoracic tumor board discussions. I'll answer the latter question first. In this case, I would not offer consolidative durvalumab.There are data that immune checkpoint inhibitors (ICIs) have minimal to no benefit in the metastatic setting base...
Is there a role for neoadjuvant chemotherapy in upper-tract urothelial carcinoma?
Very common scenario with significant variability in clinical practice. There is no standard high-level evidence as compared to muscle-invasive bladder urothelial cancer, in which neoadjuvant cisplatin-based chemotherapy is the standard of care for cisplatin-eligible patients. The literature lacks d...