Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
What changes do you make in the management of non-endemic nasopharynx cancer compared to endemic?
a) There are 3 varieties of NPC; EBER +ve, HPV +, and non-viral There is only decent data for Induction (IC) for EBER +ve for a small survival benefit with cis-gem, and the group's follow-up suggested that pre-treatment DNA titers only showed benefit for those with high titers. I am not a HN med onc...
What is the goal of estradiol levels on ovarian suppression and AI for breast cancer?
This is a sneaky difficult question. We've known since George Beatson that estrogen was important for breast cancer, and the Early Breast Cancer Trialists Collaborative Group helped get Tamoxifen approved in 1978. I've heard it said that we've had more trials looking at estrogen therapy for breast c...
How do you decide between using ropeginterferon alfa-2b and peginterferon alfa-2a in MPN?
In general, I favor ropeginterferon as it is FDA-approved and allows for less frequent, every 2-week dosing as compared to peginterferon which is used off-label and requires weekly dosing. However, ropeginterferon is not currently approved for ET and in patients where I decide to use interferon in t...
What special considerations do you take when treating cancer patients with severe intellectual disabilities?
Caring for patients with any type of disability is both a privilege and a challenge. Severe intellectual disability poses additional challenges due to logistical, ethical, and moral dilemmas. Additional factors including patients' socioeconomic status, support system, language spoken to individuals ...
Would ITCs in a single axillary node push you towards recommending adjuvant chemotherapy for a young woman with a T1a (<2mm) triple negative breast cancer?
The impact of ITCs in axillary nodes has been a subject of debate. de Boer et al., PMID 19675329 reported that adjuvant therapy reduced the risk of subsequent events in those with isolated tumor cells compared to those who did not get adjuvant therapy (hazard ratio 0.66, CI 0.46-0.95). However, a tu...
What are common indications for ordering NGS of peripheral blood?
I am delighted that someone posed this question because, in my experience as a consultant hematologist, it appears that advances in DNA sequencing technology have outstripped the knowledge base of many practitioners. This is not due to lack of interest or due diligence on their part, but rather beca...
What are common indications for ordering NGS of peripheral blood?
I am delighted that someone posed this question because, in my experience as a consultant hematologist, it appears that advances in DNA sequencing technology have outstripped the knowledge base of many practitioners. This is not due to lack of interest or due diligence on their part, but rather beca...
What, if any, resources exist with recommendations regarding the timing and toxicity of radiation in patients who have received or are currently on immunotherapy?
Concurrent immunotherapy (PD1/PDL1) with chemoradiation is now not advised, given the two negative lung cancer trials (PACIFIC 2, CheckMate 73L). Concurrent immunotherapy with radiation alone is still an interesting area to explore, as the two published studies (SPRINT, Ohri et al., PMID 37988638, a...
What would you use for cytoreduction in a pregnant patient with high risk ET and APLS?
My first instinct in replying to this question is to understand the basis for the diagnosis of “high-risk ET”. Since the patient is pregnant, the basis for the designation “high-risk” must be a history of a prior thrombotic event, either arterial or venous. However, the purveyors of the various MPN ...
What would you use for cytoreduction in a pregnant patient with high risk ET and APLS?
My first instinct in replying to this question is to understand the basis for the diagnosis of “high-risk ET”. Since the patient is pregnant, the basis for the designation “high-risk” must be a history of a prior thrombotic event, either arterial or venous. However, the purveyors of the various MPN ...