Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
What is your preferred first line therapy for metastatic cholangiocarcinoma, if the patient is cisplatin ineligible or cisplatin is unavailable?
While there is a lack of direct comparative trials, the whole development of the platinum drugs suggests oxaliplatin should be equally or more active for GI cancers. I would, therefore, use Gem-Ox, a very active regimen for pancreatic cancer, studied in phase 3 trials. Alternatively, gem-carboplatin...
Would you consider continuing or re-trialing hydroxyurea for sickle cell patients after development of a leg ulcer?
I do not think HU is the cause of leg ulcers, neither does ASJ. Habibi et al., Blood 2023 Most cases of ulcers are multifactorial and studies have also included patients with thrombocytosis (even myeloproliferative disorders!!). Low nitric oxide is part of the cause of leg ulcers in most cases. HU r...
What, if any, role does systemic therapy have in the treatment of HCC amenable to definitive locoregional therapy?
For ablation, TACE and Y90, I traditionally hold back on systemic therapy so that I have something I can use if they develop metastases. Also, sorafenib has been not shown to be effective in the adjuvant setting so I apply that principle here. Bruix et al., PMID 26361969
What is the management strategy for patients who develop AKI and nephrotic range proteinuria secondary to biopsy proven FSGS during immune checkpoint inhibitor therapy?
For glomerulonephritis induced by ICI would recommend rituximab 1 gram for a total dose of 2 doses 2 weeks apart. Based on limited case reports there has been a good response to rituximab with maintained remission of glomerulonephritis and the ability to continue on ICI without relapse. Please refer...
How would you treat an elderly patient with Stage IIA cHL with 3 nodal sites of involvement who has a contraindication to bleomycin?
With the publication of the SWOG Cancer Research Network's collaboration with the National Clinical Trials Network, Protocol S1826 results allow a definitive recommendation of nivolimab plus doxorubicin, vinblastine, and dacarbazine (N-AVD) as the treatment of choice for this patient.
How do you manage severe lenalidomide-associated drug rash in a transplant-eligible patient with multiple myeloma?
A rash with lenalidomide occurs in up to a third of patients exposed, and it's likely that dose corresponds directly with rash severity. While excellent desensitization protocols appear effective (PMID 31400463), most of us want to be able to deal with this with a phone call or text message that inc...
How do you manage severe lenalidomide-associated drug rash in a transplant-eligible patient with multiple myeloma?
A rash with lenalidomide occurs in up to a third of patients exposed, and it's likely that dose corresponds directly with rash severity. While excellent desensitization protocols appear effective (PMID 31400463), most of us want to be able to deal with this with a phone call or text message that inc...
For patients with primary CNS lymphoma and less than a CR to chemotherapy, in what situation would you consider partial or focal radiation?
For the sake of discussion, I will assume that this patient achieved a PR after a high-dose MTX regimen. If the patient is young (<60 yo) and has a good KPS (>70), I would consider using a reduced dose of WBRT (30-36) followed by a boost to the residual lesion to an equivalent dose of 45 Gy (either ...
How would you treat a synchronous low rectal adenocarcinoma and anal squamous cell carcinoma with involved pelvic and inguinal nodes?
If the patient has intact bowel/anal sphincter function at baseline, I’d favor an organ-preserving approach. I’d treat with standard pelvic + inguinal chemoradiation with a dose/fractionation scheme isoeffective with 45 Gy in 25 fractions targeting pelvis/inguinals and a dose isoeffective with 54-56...
What are your top takeaways from ASCO GU 2024?
Prostate. BRCAAway. This small but important phase 2 randomized multicenter trial of HRRm mCRPC in the first line setting demonstrated the clear synergy in delaying progression or death and inducing better response between abiraterone and olaparib as compared to either abi or olaparib monotherapy o...