Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Can docetaxel be safely given to patients with hyperbilirubinemia from Gilbert’s syndrome?
Docetaxel can be safely administered at full doses in patients with Gilbert's Syndrome. These patients usually have a variant in the UGT1A1 gene. While it can cause issues with some oncologic therapies (especially ones that rely on UGT-1A - the classic being irinotecan), it does not seem to affect t...
How would you manage a left sided triple negative breast cancer with a concurrent left sided locally advanced non-small cell lung cancer?
The presentation of two primary cancers that carry serious prognoses is very challenging. There are many variables at play here that could alter the initial therapeutic approach and ongoing treatment. Assuming this patient has a reasonable KPS, PFTs, and can undergo surgery, one way to start is neoa...
Would you use olaparib after progression on an ARPI for a patient with somatic PALB2 mutated mCRPC?
Yes, I would consider using olaparib monotherapy in a sPALB2-altered patient who has previously received one or more ARPI agents. This is based on a recent meta-analysis conducted by the FDA. In that paper, in PALB2-mutated mCRPC patients (N total = 41) rPFS HR was 0.52 (0.23 to 1.17) and OS HR was ...
How do you manage hyperalgesia in patients with sickle cell disease?
In addition to the obvious, such as PCA narcotics, Lyrica/Neurontin, and Toradol, I have success with IV Tylenol, Zyprexa, po L-Arginine (Morris et al., PMID 23645695) as well as Dexmedetomidine (Precedex), steroids (NEJM: Griffin et al., PMID 8107739) and acupuncture [Johnson et al., Alternative an...
What hemoglobin level do you target for adult beta thalassemia intermedia patients with a pre-transfusion Hb >7 g/dl?
If they have been evaluated by a thalassemia expert and considered to be transfusion dependent then the target minimum pre-transfusion is 9.5 -10, but if that hemoglobin is not adequate to improve quality of life and the patient feels the need for higher hemoglobin to catch with daily work and activ...
What are your top takeaways from ASCO GI 2023?
Top 3 radiation oncology studies: Abstract 489- NRG/RTOG 1112 presented at ASTRO but only phase III study to establish the role of liver SBRT in HCC; will SBRT supplant radioembolization given the 3 negative phase III studies for radioembolization in contrast to this positive study for SBRT Abstract...
Will you consider definitive concurrent chemoradiation for stage IV lung adenocarcinoma with metastasis limited to an internal mammary lymph node?
I'd certainly consider it upfront if lung and cardiac constraints can be reasonably met. There have been a few small series now demonstrating good outcomes in patients who received definitive chemoradiation to thoracic disease in the setting of limited metastatic disease. Generally, I would favor an...
For patients with metastatic thymic carcinoma, is there a role for local treatment options such as SBRT for oligoprogressive or oligopersistent disease after systemic therapy?
Of course, there is no data on this question for people with thymic carcinoma. Metastatic thymic carcinoma is generally treated with systemic therapy which is guided to some extent by the histologic subtype of the tumor. Most commonly, we would utilize a regimen such as CAP (cyclophosphamide, doxoru...
What is the consensus on giving Pemivibart for Pre-Exposure COVID prophylaxis in immunocompromised patients?
The SARS-COV2 virus that caused COVID-19 infection in the early pandemic caused significant morbidity and mortality to immunocompromised patients including those with blood cancers. Therapies such as remdesivir, paxlovid, antibody neutralizing therapeutics Evusheld antibody for prophylaxis, and the ...
What is the consensus on giving Pemivibart for Pre-Exposure COVID prophylaxis in immunocompromised patients?
The SARS-COV2 virus that caused COVID-19 infection in the early pandemic caused significant morbidity and mortality to immunocompromised patients including those with blood cancers. Therapies such as remdesivir, paxlovid, antibody neutralizing therapeutics Evusheld antibody for prophylaxis, and the ...