Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How would you approach post-operative VTE prophylaxis for renal transplant in patients with a prior history of provoked VTE?
I am not aware of published systematic reviews, risk models, or evidence-based guidelines for post-operative prophylaxis in renal transplant patients. Given both increased risk for VTE and bleeding, it is not surprising that there is a large variation in practice (for relatively recent survey on t...
Do you consider post-NAC isolated tumor cells in LNs to be residual disease in TNBC to justify capecitabine?
The brief answer is yes, I would. These patients were included in the CREATE-X trial (Masuda et al., PMID 28564564). Also, there is data out of Boston that following neoadjuvant chemotherapy, patients with even isolated tumor cells in lymph nodes have a poorer prognosis (Wong et al., PMID 31228134)....
What is your preferred therapy for CDK12-altered advanced prostate cancer, outside clinical trial?
CDK12-mutated prostate cancers are aggressive and typically respond less favorably to AR-directed therapies. The CDK12 gene was on the eligibility list for the PROfound study, so olaparib could be used for mCRPC patients who have progressed on at least one AR-directed agent. In the CDK12-altered sub...
Do you use endocrine therapy concurrently or sequentially with radiation therapy in hormone receptor positive breast cancer patients?
I do it concurrently for patients with high burden of disease (several lymph node positive). Otherwise, I wait as it's likely safe to postpone endocrine therapy a few weeks to after radiation therapy and spare patients concurrent side effects.
How do you choose between the different recently approved Bispecifics Antibodies for Relapsed/Refractory Multiple Myeloma?
I would pick BCMA directed BsAbs first, treat on label (weekly or q 2 week) to best response and then space out the schedule to q 4 weeks (or even q 8 weeks). Basing this on 6+ years experience of using BsAbs in FIH/PI-III as well in the commercial setting. The way to mitigate infections/AEs will be...
How will you decide who to offer ramucirumab + pembro after progression on chemoimmunotherapy?
In S1800A, overall survival benefit was relatively consistent across subgroups including TMB levels and PD-L1 strata. I would take into account the patient’s prior response to ICI (extent and duration) and the side effects from the ICI therapy. For instance, I would favor chemotherapy for those with...
For patients diagnosed with T-cell lymphoblastic lymphoma with CNS involvement (CSF), what is your approach to the typical schedule for IT chemotherapy?
In general, the schedule of IT chemotherapy is dictated by the systemic chemotherapy regimen chosen. For example, with a pediatric-inspired regimen like C10403, those with CNS involvement receive more LPs during the Remission Induction course. For hyperCVAD, the historical approach has been to give ...
How do you manage a DOAC if interested in testing for lupus anticoagulant?
Testing for anti-phospholipid antibodies encompasses two broad categories of testing. One is an ELISA based (aka solid phase) set of tests that include anti-cardiolipin and anti-beta 2 glycoprotein I antibodies. ELISA assay are not affected by DOACs. For the second lupus anticoagulant (aka fluid pha...
How would you treat a patient with Hodgkin lymphoma who has an isolated relapse within the CNS?
It's challenging to offer specific advice in this situation without knowing a lot more. First, it's important to recognize that CNS involvement by classical Hodgkin lymphoma is extremely rare and strictly requires a brain biopsy to make a diagnosis (even in a patient with active systemic CHL, a seco...
How would you treat a patient with Hodgkin lymphoma who has an isolated relapse within the CNS?
It's challenging to offer specific advice in this situation without knowing a lot more. First, it's important to recognize that CNS involvement by classical Hodgkin lymphoma is extremely rare and strictly requires a brain biopsy to make a diagnosis (even in a patient with active systemic CHL, a seco...