Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
For recurrent glioblastoma treated with combined re-irradiation and bevacizumab, how long do you continue bevacizumab?
In the event of recurrent GBM, for example, if i.e. fSRT regimen like 30 Gy/5fx to be used for salvage, would not exceed more than 12 doses (6 cycles) of bevacizumab max. Even in the pseudo-response setting, the toxicity far outweighs the benefit beyond this.
Would you consider a D2 gastrectomy in young fit patients with gastric adenocarcinoma and positive peritoneal cytology without macroscopic disease if cytology turned negative after neoadjuvant chemotherapy?
Negative peritoneal mycology plus very good objective response in the primary in a very young and healthy patient would be reasonable to remove the primary with the understanding there is still a significant risk of well over fifty percent of not curing the patient. This is a very highly selective s...
Would you offer neoadjuvant chemoimmunotherapy per KEYNOTE 522 for a patient with clinical stage IIB triple-negative breast cancer with apocrine histology or recommend surgery first?
Apocrine subtype of TNBC typically has a better prognosis but a poorer response to chemotherapy. Since this is a rarer subtype, most of the evidence comes from real-world experience and anecdotal reports. Smaller data sets have suggested that AC-T may not be needed in these patients and docetaxel an...
Is a very rapidly rising WBC count ever an indication for the upfront treatment of CLL?
This situation, fortunately, does not arise frequently in CLL. But, when it does occur, it is a vexing question. According to the recommendations and guidelines of iwCLL, in absolute terms, the answer (to this question which is worded very carefully) is "NO". But, in my view, there is room for some ...
Is a very rapidly rising WBC count ever an indication for the upfront treatment of CLL?
This situation, fortunately, does not arise frequently in CLL. But, when it does occur, it is a vexing question. According to the recommendations and guidelines of iwCLL, in absolute terms, the answer (to this question which is worded very carefully) is "NO". But, in my view, there is room for some ...
How do you manage prophylactic antimicrobial medications in patients who undergo ATG/cyclosporine/eltrombopag induction for severe aplastic anemia?
Yes for prophylactic antibacterials after ATG/cyclosporine and eltrombopag treatment of AA. Antiviral with valtrex 500mg oral twice daily and PJP prophylaxis while on immunosuppression with cyclosporine.Antibacterial with levofloxacin and antifungal prophylaxis with posaconazole 300mg oral daily or ...
How do you manage prophylactic antimicrobial medications in patients who undergo ATG/cyclosporine/eltrombopag induction for severe aplastic anemia?
Yes for prophylactic antibacterials after ATG/cyclosporine and eltrombopag treatment of AA. Antiviral with valtrex 500mg oral twice daily and PJP prophylaxis while on immunosuppression with cyclosporine.Antibacterial with levofloxacin and antifungal prophylaxis with posaconazole 300mg oral daily or ...
Do you generally reduce DOAC dosing for extended anticoagulation in patients with first unprovoked VTE?
I frequently recommend low-intensity DOAC therapy in this setting, but only after careful consideration of the patient's risk factors for recurrent VTE and bleeding, and after determining the patient's preference about treatment options following a discussion of the pros and cons of each option.
Do you generally reduce DOAC dosing for extended anticoagulation in patients with first unprovoked VTE?
I frequently recommend low-intensity DOAC therapy in this setting, but only after careful consideration of the patient's risk factors for recurrent VTE and bleeding, and after determining the patient's preference about treatment options following a discussion of the pros and cons of each option.
Can durvalumab incorporation to gem+cis for advanced BTCs allow for earlier discontinuation of cytotoxic chemotherapy in patients exhibiting response?
The TOPAZ-1 study was double blinded, and there were no meaningful differences in gemcitabine/cisplatin treatment duration between the groups. I do not intend to give fewer cycles of gemcitabine/cisplatin now that durvalumab has been added to the armamentarium. In the past, I would usually discuss m...