Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Do you offer local consolidative therapy for patients with polymetastatic driver mutation-positive NSCLC who respond well to targeted therapy?
This is a great question. In phase II prospective study, Gomez and colleagues (Gomez et al., PMID 31067138) demonstrated a PFS and OS benefit with local consolidative therapy in patients whose disease did not progress after first-line systemic therapy. In my opinion, local consolidation therapy to o...
What is your approach to solitary node positive bladder cancer (e.g. N1) in a patient who is otherwise a candidate for either bladder preservation or radical cystectomy?
This is a very intriguing question, with limited prospective data to guide us. I will frame my response on a patient with clinical node positive (based on imaging) bladder cancer and a candidate for bladder preservation or cystectomy. This patient is deemed metastatic yet there may be a subset of t...
What subset of sickle cell disease patients are you offering sickle cell disease gene therapy?
All patients with Hgb SS and patients with Hgb SC who have had any significant complications, excluding chronic pain.
When do you refer AYA patients with newly diagnosed severe aplastic anemia for transplant?
In a young person, my first thought is to obtain telomere lengths to be sure he/she does not have a telomeropathy. This has significant implications both with and without transplantation. Certainly, if telomeres are short, allogeneic transplantation is preferred since there is less likelihood of res...
When do you refer AYA patients with newly diagnosed severe aplastic anemia for transplant?
In a young person, my first thought is to obtain telomere lengths to be sure he/she does not have a telomeropathy. This has significant implications both with and without transplantation. Certainly, if telomeres are short, allogeneic transplantation is preferred since there is less likelihood of res...
How do you approach adjuvant chemotherapy in resected T4N0 colon cancer?
How would you approach adjuvant treatment for a premenopausal woman with a large, lymph node positive HR+, Her2 negative lobular breast cancer?
In pure or classical estrogen receptor positive lobular breast cancers neoadjuvant chemotherapy works very poorly (3% vs 15% pCR; Cristofanilli et al. J Clin Oncol 2005;23:41-8) and you are not likely to convert mastectomy to lumpectomy. I would strongly consider neoadjuvant endocrine therapy, espec...
Do you consider prophylactically increasing eculizumab frequency for pregnant or postpartum PNH patients?
Yes, there have been several case series and reports indicating that eculizumab may need to be prophylactically increased in dose or frequency (because the pregnancy state may further increase complement activation in PNH patients). This efficacy of eculizumab may be monitored by standard hemolysis ...
Would you consider adding atezolizumab to chemotherapy for metastatic esophageal small cell cancer?
I would consider adding atezolizumab (and indeed I have in the past). Of course, this would be based on the SCLC literature from the IMpower133 and CASPIAN trials where atezolizumab and durvalumab respectively improved outcomes when combined with platinum/etoposide chemotherapy. But there is a cavea...
How do you treat triple positive essential thrombocythemia with evidence of fibrosis on bone marrow biopsy, but does not meet diagnostic criteria for myelofibrosis?
My first thought upon encountering this question was that there must have been a typographical error and the writer actually meant “negative”, not positive, because “triple positive” essential thrombocythemia (ET) is an oxymoron. MPN driver mutations are not mutually exclusive with respect to their ...