Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Would you recommend additional post-operative chemoradiation for a T2N1 proximal rectal cancer having received adjuvant capecitabine/oxaliplatin?
Pathologic T2N1 after high-quality R0 TME, in an otherwise favorable pelvic risk patient (per pre-op staging MRI) with upper rectal cancer, would not be sufficient for me to recommend post-op CRT as I don’t think there would be a clinically significant benefit that would warrant the known acute and ...
Do you recommend shingles vaccine to all immunosuppressed patients under the age of 50 y.o.?
This is an interesting question. Clearly, patients with autoimmune or immune-mediated diseases because of their immunosuppressed status are at an increased risk of H. zoster, regardless of age. Presently, the recommendations from the CDC, different professional societies, etc., are to immunize patie...
How would you approach a 2 cm malignant primary cutaneous adnexal adenocarcinoma of the axilla s/p resection with positive margin who is unable to undergo additional surgery?
I would consider imaging of the regional node basin (axilla) first. If there was evidence of regional lymph node metastasis, I would image the body to evaluate for distant metastases. If there was distant metastasis, I would probably refer for systemic therapy. If there was no distant metastasis, ...
Are there patients who can forgo anticoagulation with asymptomatic, incidentally discovered subsegmental pulmonary embolism?
Of note, there are two ongoing clinical trials that should hopefully provide further data on the definitive management of SSPE (NCT01455818, NCT04263038).
Are there patients who can forgo anticoagulation with asymptomatic, incidentally discovered subsegmental pulmonary embolism?
Of note, there are two ongoing clinical trials that should hopefully provide further data on the definitive management of SSPE (NCT01455818, NCT04263038).
Do you use modified FOLFIRINOX preferentially over gem/nab-paclitaxel for first line metastatic pancreatic cancer patients?
Over and beyond patient characteristics, I prioritize mfolfirinox in pancreatic ductal adenocarcinoma patients with (i) known somatic or germ line alterations in DNA Damage Repair genes and (ii) in patients with a high likelihood of such alterations based on clinical/family history (if somatic or ge...
For mild to moderate hemophilia B, do you routinely screen for inhibitors?
Most experts recommend testing for an inhibitor within 6 to 12 months after concentrate therapy, before any major surgery, and if the patient has a poor response to concentrate therapy (lower than the expected level achieved, or shortened half-life). An annual test is also recommended. WFH Guideline...
How do you approach a women with localized HER2+ breast cancer that was HER2+ by FISH but negative (0+) by IHC?
This is challenging, but since HER2 amplification by FISH is defined as HER2 positive by ASCO/CAP guildeines, if the patient is fit for consideration of HER2-directed therapy with chemotherapy, I would still proceed with those regimens.
Is there an optimal bridging radiation dose for aggressive B-cell NHL undergoing CAR T-cell therapy?
The perfect radiation dose for a given patient probably depends on a number of patient and disease-specific factors including tumor biology and genetics, the anatomy of the tumor and adjacent organs at risk, and the radiation technique used. We do not have the ability to recommend such individualize...
How do you approach an ITP patient who responds very well to steroids but the response is short-lived?
Introduce second line therapy. Rituxan pr TPO-RA.