Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How would you treat a de novo CLL with WBC of 1,000,000 and no overt signs of leukostasis?
This is an interesting question. I haven't seen anyone with a WBC count this high except when they had other factors influencing the count such as dehydration or systemic infection such as c diff and it was a reactive process in addition to CLL. It would be interesting to know what else was going on...
Would you consider induction chemotherapy prior to starting chemoradiation therapy in squamous cell carcinoma of the esophagus?
Time and again, studies have shown that induction therapy for squamous cell carcinoma, seemingly regardless of primary tumor origin, probably does not improve the outcomes for patients compared to upfront chemoradiation therapy. For example in Head & Neck squamous cell cancers, the use of induction ...
Do you use denosumab for castration-sensitive prostate cancer with osseous metastases?
This is an important question but a complex one. Several issues are critical to consider: 1) bone anti-resorptive therapies like zoledronic acid have NOT been established to improve survival or reduce skeletal events in this setting of bone metastatic HSPC as compared to waiting for mCRPC. See CALGB...
How do you manage docetaxel or other taxane-induced nail toxicity?
A variety of nail conditions have been reported with chemotherapy, particularly with docetaxel. There are no proven prevention strategies for taxane-induced nail toxicity. However, there are limited data that the cooling of extremities may help prevent nail complications (Scotte, F, Cancer 2008) but...
What is the optimal age at which a patient with sickle cell disease should undergo allogeneic stem cell transplant?
Ideally, would be at diagnosis to limit sickle related injury and generally, younger patients have less complications but since curative treatment is not perfect, it depends mainly on the donor. For matched sibling donor transplant, under age 5yrs has best outcomes with over 15yrs having more GVHD a...
What is the optimal age at which a patient with sickle cell disease should undergo allogeneic stem cell transplant?
Ideally, would be at diagnosis to limit sickle related injury and generally, younger patients have less complications but since curative treatment is not perfect, it depends mainly on the donor. For matched sibling donor transplant, under age 5yrs has best outcomes with over 15yrs having more GVHD a...
What is the role of adjuvant chemotherapy in a desmoid tumor after R2 resection?
None. In the unfortunate event of an R2 resection, the recommended approach would be to watch/follow the residual disease serially. If indeed progressive and/or symptomatic, then consider options including (?) completion surgery, XRT, or systemic therapy, ideally decided after a multidisciplinary di...
What factors do you consider when sequencing bispecific T-cell engaging antibodies and CAR T-cell therapies for the treatment of follicular lymphoma?
I always choose CART first. It is unclear how much bispecific antibodies will affect CART manufacturing or T-cell fitness. There is a good date of efficacy post CART relapsed with bispecific antibodies.
What factors do you consider when sequencing bispecific T-cell engaging antibodies and CAR T-cell therapies for the treatment of follicular lymphoma?
I always choose CART first. It is unclear how much bispecific antibodies will affect CART manufacturing or T-cell fitness. There is a good date of efficacy post CART relapsed with bispecific antibodies.
How would you treat a young patient with a resected stage III chromophobe RCC?
Good question, while it is tempting to give adjuvant pembro given stage III we don’t know that chromophobes will respond. Wondering if there’s a specific trial for this. Adjuvant non-clear cell.