Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Would you change therapy for a CML patient in hematologic remission on imatinib found with positive qualitative BCR-ABL1 for the p230 protein?
It would depend on how long the patient has been on imatinib and the sensitivity of PCR testing. Being able to monitor the p230 transcript at the level of 0.1% or even deeper would be helpful to characterize if the patient has achieved a major molecular response or not. This publication outlines the...
What is your approach for bulky stage I primary mediastinal B-cell lymphoma in a patient with a positive post-chemotherapy PET-CT (residual mass and Deauville 5)?
Interpreting end-of-treatment PET in PMBL can be tricky. False positives here are very common! Fake-outs include thymic rebound masquerading as refractory disease; avidity at rim (which is almost always biopsy-neg); or residual avidity throughout residual mass which again can be biopsy negative. I w...
What is your approach for bulky stage I primary mediastinal B-cell lymphoma in a patient with a positive post-chemotherapy PET-CT (residual mass and Deauville 5)?
Interpreting end-of-treatment PET in PMBL can be tricky. False positives here are very common! Fake-outs include thymic rebound masquerading as refractory disease; avidity at rim (which is almost always biopsy-neg); or residual avidity throughout residual mass which again can be biopsy negative. I w...
How would you approach therapy for a nasal high grade neuroendocrine tumor with ipsilateral local cervical adenopathy?
A couple of additional thoughts on work-up: Is the pathologist calling this small cell histology (as opposed to SNUC, esthesioneuroblastoma, etc) or a low grade NEC? I would also request tumor NGS and PD-L1. MRI brain to r/o mets if not done already should be considered. If it is high grade, I wou...
What is the preferred chemotherapy regimen for a patient with bladder adenocarcinoma with signet ring features?
Signet ring cell variants are considered an aggressive phenotype of urinary bladder adenocarcinoma with poor outcome. Because of the rarity, evidence based treatment approach is unknown. There are anecdotal experience in the literature.For example, a long term survival of 90 months was reported for ...
Does aspirin dose (81 mg vs 325 mg) matter for secondary stroke prevention?
This topic has been debated extensively. There are two camps in this debate: Aspirin with a dose of 81 mg is adequate for platelet inhibition in the general population. Aspirin with a dose of 325 mg may be needed for individuals who weigh more (>70 kg) to achieve appropriate platelet inhibition. T...
Are you including Bortezomib as standard of care in the upfront treatment of T lymphoblastic-lymphoma?
We do use bortezomib in the upfront treatment of T-cell lymphoblastic lymphoma in children and AYA. For those familiar with the topic, the results of two successive large clinical trials in T-LLy done by COG, AALL0434, and AALL1231, were confusing. Due to the rarity of the disease, overlapping trial...
Would you offer adjuvant systemic therapy for recurrent fallopian tube leiomyosarcoma after resection of an isolated liver metastasis that presented within 1 year from primary surgery?
If this was an R0 resection, then I would not offer adjuvant therapy. It would be beneficial to understand if this is a high-grade or a low-grade leiomyosarcoma and also the ER/PR status. If strongly positive, then perhaps maintenance aromatase inhibitor can be considered, however, there is no good ...
In high or very high risk prostate cancer, do you utilize combined androgen blockade in patients receiving definitive RT?
Since I had initially posted this, the STAMPEDE investigators have released a new publication reporting the utility of intensified androgen axis blockade (abiraterone ± enzalutamide) in high-risk non-metastatic patients which included high-risk N0 (≈ 60%) and N1 patients (≈ 40%). For this combined p...
What adjuvant chemotherapy regimen do you recommend for a patient with T1cN0 TNBC?
This is such a nuanced question that comes up with our fellows and affiliates a lot. I will give my take on this, although I want to acknowledge there are still pockets of uncertainty here!I want to start by saying that in the purely adjuvant setting, we have the ABC trials (USOR 06-090, NSABP-B46I/...