Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How do you determine duration of anticoagulation for an ovarian vein thrombosis following a provoking event?
This specific question has not been addressed in a clinical trial to my knowledge. If the patient is symptomatic, I would anticoagulate for 3 months in the absence of a contraindication, just as I would for most other provoked VTE events. One might consider a watch and wait approach without anticoag...
How do you determine duration of anticoagulation for an ovarian vein thrombosis following a provoking event?
This specific question has not been addressed in a clinical trial to my knowledge. If the patient is symptomatic, I would anticoagulate for 3 months in the absence of a contraindication, just as I would for most other provoked VTE events. One might consider a watch and wait approach without anticoag...
Is it appropriate to substitute vincristine for vinblastine in ABVD for systemic therapy of Hodgkins lymphoma?
I would give vinorelbine.
Is it appropriate to substitute vincristine for vinblastine in ABVD for systemic therapy of Hodgkins lymphoma?
I would give vinorelbine.
Do you offer adjuvant chemotherapy to patients with rectal cancer who were on Watch-and-Wait, had local recurrence and underwent resection?
I would not. Watch and wait indicates the patient already received some form of chemotherapy and I do not know that additional chemo after removing a regrowth of the tumor will make much or any difference.
What is the appropriate treatment approach for a primary squamous cell carcinoma of the trachea?
Treating tracheal malignancies is obviously challenging. I typically determine treatment based on the location of the primary. Upper tracheal (above the sternal notch) I treat more like a HN cancer while below that I treat more like a lung cancer. Upper tracheal cancer are more difficult to resect d...
Do you hold nivolumab and ipilimumab when giving palliative radiation to abdominal targets?
This is similar to the question of whether you should hold bevacizumab for palliative radiation. You cannot really change the biologic effects of these agents immediately by holding them. The toxicity has been repeatedly shown to be minimal in trials where radiation has been included with concurrent...
Is there a role of adjuvant or systemic therapy for patients with resected stage I colon cancer with subsequent local recurrence S/P a second resection and now has NED?
Tough question. Depending on the numbers, there is literature to suggest 5% recurrence and also in some ctDNA series of similar numbers have recurrence.In general, it would not be unreasonable to offer some systemic. However, the decision to consider that would be in the context of: Clinical details...
Outside of a clinical trial, how do you approach upfront therapy for a PDGFRA D842V-mutant GIST?
These are usually indolent surgical tumors (until they are not) that belong in the care of a sarcoma center and not in the community. There are two trials of agents that are being tested for D842V mutations at this time (NCT02508532 and NCT02847429).
What are your treatment recommendations in a patient with de novo metastatic prostate adenocarcinoma with neuroendocrine differentiation?
Neuroendocrine prostate cancer more often arises as a mechanism of treatment resistance than de novo, but in either case, portends aggressive disease biology and androgen insensitivity. Similar to the features of “aggressive-variant” prostate cancer described by Aparicio et al., PMID 26546618, the d...