Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
For patients with primary CNS lymphoma and less than a CR to chemotherapy, in what situation would you consider partial or focal radiation?
For the sake of discussion, I will assume that this patient achieved a PR after a high-dose MTX regimen. If the patient is young (<60 yo) and has a good KPS (>70), I would consider using a reduced dose of WBRT (30-36) followed by a boost to the residual lesion to an equivalent dose of 45 Gy (either ...
How would you treat a synchronous low rectal adenocarcinoma and anal squamous cell carcinoma with involved pelvic and inguinal nodes?
If the patient has intact bowel/anal sphincter function at baseline, I’d favor an organ-preserving approach. I’d treat with standard pelvic + inguinal chemoradiation with a dose/fractionation scheme isoeffective with 45 Gy in 25 fractions targeting pelvis/inguinals and a dose isoeffective with 54-56...
What are your top takeaways from ASCO GU 2024?
Prostate. BRCAAway. This small but important phase 2 randomized multicenter trial of HRRm mCRPC in the first line setting demonstrated the clear synergy in delaying progression or death and inducing better response between abiraterone and olaparib as compared to either abi or olaparib monotherapy o...
For recurrent glioblastoma treated with combined re-irradiation and bevacizumab, how long do you continue bevacizumab?
In the event of recurrent GBM, for example, if i.e. fSRT regimen like 30 Gy/5fx to be used for salvage, would not exceed more than 12 doses (6 cycles) of bevacizumab max. Even in the pseudo-response setting, the toxicity far outweighs the benefit beyond this.
Would you consider a D2 gastrectomy in young fit patients with gastric adenocarcinoma and positive peritoneal cytology without macroscopic disease if cytology turned negative after neoadjuvant chemotherapy?
Negative peritoneal mycology plus very good objective response in the primary in a very young and healthy patient would be reasonable to remove the primary with the understanding there is still a significant risk of well over fifty percent of not curing the patient. This is a very highly selective s...
Would you offer neoadjuvant chemoimmunotherapy per KEYNOTE 522 for a patient with clinical stage IIB triple-negative breast cancer with apocrine histology or recommend surgery first?
Apocrine subtype of TNBC typically has a better prognosis but a poorer response to chemotherapy. Since this is a rarer subtype, most of the evidence comes from real-world experience and anecdotal reports. Smaller data sets have suggested that AC-T may not be needed in these patients and docetaxel an...
Is a very rapidly rising WBC count ever an indication for the upfront treatment of CLL?
This situation, fortunately, does not arise frequently in CLL. But, when it does occur, it is a vexing question. According to the recommendations and guidelines of iwCLL, in absolute terms, the answer (to this question which is worded very carefully) is "NO". But, in my view, there is room for some ...
Is a very rapidly rising WBC count ever an indication for the upfront treatment of CLL?
This situation, fortunately, does not arise frequently in CLL. But, when it does occur, it is a vexing question. According to the recommendations and guidelines of iwCLL, in absolute terms, the answer (to this question which is worded very carefully) is "NO". But, in my view, there is room for some ...
How do you manage prophylactic antimicrobial medications in patients who undergo ATG/cyclosporine/eltrombopag induction for severe aplastic anemia?
Yes for prophylactic antibacterials after ATG/cyclosporine and eltrombopag treatment of AA. Antiviral with valtrex 500mg oral twice daily and PJP prophylaxis while on immunosuppression with cyclosporine.Antibacterial with levofloxacin and antifungal prophylaxis with posaconazole 300mg oral daily or ...
How do you manage prophylactic antimicrobial medications in patients who undergo ATG/cyclosporine/eltrombopag induction for severe aplastic anemia?
Yes for prophylactic antibacterials after ATG/cyclosporine and eltrombopag treatment of AA. Antiviral with valtrex 500mg oral twice daily and PJP prophylaxis while on immunosuppression with cyclosporine.Antibacterial with levofloxacin and antifungal prophylaxis with posaconazole 300mg oral daily or ...