Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
In a patient with amyloidosis and abnormal liver function but child Pugh A, would you still proceed with SABR for a liver metastasis?
No great data regarding the impact of amyloidosis on liver tolerance, but if the patient was a CP Class A patient, I would feel comfortable offering SABR for a liver metastasis.
What criteria do you use for induction chemotherapy in advanced head and neck cancers?
We were advocates of IC for patients felt to be at higher risk for DM in oropharynx cancer. We believed these were patients with N2b-N3 disease. However, the recent PARADIGM and DeCIDE trials were negative for a survival advantage for IC, so personally my enthusiasm for IC for advanced oropharynx ca...
How do you approach management of locally-advanced, unresectable, but non-metastatic bladder cancer?
"Locally advanced" has a broad meaning. I will focus on muscle invasive urothelial carcinoma which is non-metastatic, node negative, and does not invade the pelvic or abdominal wall, and is a maximum of T4a, N0, M0 disease, and in those patients who either have unresectable disease or who are not su...
How would you treat a patient with borderline resectable pancreatic cancer with CT showing no change in tumor size after 4 cycles of neoadjuvant FOLFIRINOX?
This is a great question. We have an in-house protocol that is trying to answer this exact question with built-in, arbitrary parameters for clinical, biochemical, and radiographic response to ascertain whether or not to switch to a non-cross resistant chemotherapy regimen after 2 months of neoadjuva...
How would you manage anticoagulation in a patient with acute MI or PE with prolonged aPTT due to congenital factor XII deficiency?
You can monitor anti Xa levels.
How would you treat an older patient with multiple co-morbidities and borderline performance status with resectable esophageal cancer in light of ESOPEC trial?
This is a great question. There is lacking data to answer your question, so you are getting my professional opinion and that which I heard discussed at the recent Best of ASCO by Binaytara. The simple answer: yes. We as oncologists need to know the data, know what is "optimal" and individualize for...
Would an MPL variant mutation of unknown clinical significance be considered diagnostic of essential thrombocytosis in a patient with longstanding elevation in the platelet count, and for whom all secondary causes have been excluded?
A bone marrow biopsy should be performed if not already done to complete diagnostic work-up for an MPN. If the MPL variant is truly of unknown significance, then that alone is not diagnostic of an MPN. The WHO 5th edition criteria for ET diagnosis are summarized in Loghavi et al., PMID 38043791 and ...
Would an MPL variant mutation of unknown clinical significance be considered diagnostic of essential thrombocytosis in a patient with longstanding elevation in the platelet count, and for whom all secondary causes have been excluded?
A bone marrow biopsy should be performed if not already done to complete diagnostic work-up for an MPN. If the MPL variant is truly of unknown significance, then that alone is not diagnostic of an MPN. The WHO 5th edition criteria for ET diagnosis are summarized in Loghavi et al., PMID 38043791 and ...
How do you approach adjuvant treatment of pT1cN0 metaplastic triple negative breast cancer?
Triple negative metaplastic breast cancers (TNMetBC) are rare, relatively chemorefractory tumors that behave quite differently from triple negative ductal cancers. (Reddy et al., PMID 33148288) The two types are usually treated similarly due to a lack of conclusive data on how to optimally treat TNM...
What is your perioperative approach to holding and restarting hydroxyurea in patients with essential thrombocythemia?
I would like to rephrase the question since as written, the assumption is that hydroxyurea is a preferred therapy for ET, when any careful reading of the literature will show that there is no proven rationale for using chemotherapy of any sort routinely in ET. There is no association between the pla...