Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
What is the preferred chemotherapy regimen for a patient with bladder adenocarcinoma with signet ring features?
Signet ring cell variants are considered an aggressive phenotype of urinary bladder adenocarcinoma with poor outcome. Because of the rarity, evidence based treatment approach is unknown. There are anecdotal experience in the literature.For example, a long term survival of 90 months was reported for ...
Does aspirin dose (81 mg vs 325 mg) matter for secondary stroke prevention?
This topic has been debated extensively. There are two camps in this debate: Aspirin with a dose of 81 mg is adequate for platelet inhibition in the general population. Aspirin with a dose of 325 mg may be needed for individuals who weigh more (>70 kg) to achieve appropriate platelet inhibition. T...
Are you including Bortezomib as standard of care in the upfront treatment of T lymphoblastic-lymphoma?
We do use bortezomib in the upfront treatment of T-cell lymphoblastic lymphoma in children and AYA. For those familiar with the topic, the results of two successive large clinical trials in T-LLy done by COG, AALL0434, and AALL1231, were confusing. Due to the rarity of the disease, overlapping trial...
Would you offer adjuvant systemic therapy for recurrent fallopian tube leiomyosarcoma after resection of an isolated liver metastasis that presented within 1 year from primary surgery?
If this was an R0 resection, then I would not offer adjuvant therapy. It would be beneficial to understand if this is a high-grade or a low-grade leiomyosarcoma and also the ER/PR status. If strongly positive, then perhaps maintenance aromatase inhibitor can be considered, however, there is no good ...
In high or very high risk prostate cancer, do you utilize combined androgen blockade in patients receiving definitive RT?
Since I had initially posted this, the STAMPEDE investigators have released a new publication reporting the utility of intensified androgen axis blockade (abiraterone ± enzalutamide) in high-risk non-metastatic patients which included high-risk N0 (≈ 60%) and N1 patients (≈ 40%). For this combined p...
What adjuvant chemotherapy regimen do you recommend for a patient with T1cN0 TNBC?
This is such a nuanced question that comes up with our fellows and affiliates a lot. I will give my take on this, although I want to acknowledge there are still pockets of uncertainty here!I want to start by saying that in the purely adjuvant setting, we have the ABC trials (USOR 06-090, NSABP-B46I/...
Would you prescribe TKIs for Stage IV differentiated thyroid cancer patients who are RAI-naive, with preserved performance status, and are not eligible for surgery?
TKI therapies, including those targeting RET, NTRK, and BRAF are indicated for patients with RAI-refractory disease. I am assuming the patient in question has locally advanced disease that requires surgery, but is too advanced for resection. Presently, we do not have data to support the use of TKI t...
Is there any indication for hydroxyurea in patients with sickle cell trait?
No. Of course, be sure it is the correct diagnosis and not HgA + HgS (beta+) which, as you know, shows HgA and HgS on electrophoresis and can/will be called trait if not looked at by someone experienced to note if A> S or if S > A. If MCV is low. If HgA2 is up. HgF up etc... If indirect Bili/LDH/AST...
Would you start anticoagulation in a patient with provoked blood clot in the past now with labs done for rheumatological reasons showing triple positive APLA?
The short answer is that I would probably not anticoagulate this patient as a history of prior thrombosis is hard to connect to the currently positive APL antibodies. I would certainly obtain a second set for future risk stratification. However, there are several variables that could influence the ...
How would you approach treatment for a glioblastoma from a radiation standpoint that was initially thought to be a metastases and therefore treated with multiple courses of SRS over the past few years?
It appears that the patient was empirically treated with multiple SRS courses; then, presumably, the patient must have undergone a biopsy/resection which disclosed the true nature of the problem (GBM). Therefore, the question is, what is the appropriate postop treatment for this patient? There are s...