Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
What frontline therapy would you offer for a patient who is elderly or unfit for standard induction therapy with both IDH-2 and FLT-3 ITD mutations?
For a newly diagnosed patient, unfit for induction chemotherapy with both an IDH2 and FLT3 mutation, I would offer HMA with venetoclax for the initial treatment. While both the IDH2 inhibitor Enasidenib and the FLT3 inhibitor Gilteritinib are both well-tolerated drugs with good remission rates, if y...
What frontline therapy would you offer for a patient who is elderly or unfit for standard induction therapy with both IDH-2 and FLT-3 ITD mutations?
For a newly diagnosed patient, unfit for induction chemotherapy with both an IDH2 and FLT3 mutation, I would offer HMA with venetoclax for the initial treatment. While both the IDH2 inhibitor Enasidenib and the FLT3 inhibitor Gilteritinib are both well-tolerated drugs with good remission rates, if y...
Do you resume zoledronic acid or denosumab at relapse in multiple myeloma?
This is generally a data free zone. Remember at induction, the overall survival benefit with Zometa is ONLY in patients with myeloma bone disease achieving less than a partial response to induction. The skeletal related event (SRE) risk reduction compared to placebo was dependent on myeloma control ...
How would you manage a patient with PV or ET who is experiencing breakthrough thrombosis?
The first question I would ask in this clinical situation is, "does the patient have PV or ET?"; a patient cannot have both. Unfortunately, I encounter this situation too often in my clinical practice. There appears to be a curious but dangerous belief in the medical community that ET is a more sero...
How would you manage a patient with PV or ET who is experiencing breakthrough thrombosis?
The first question I would ask in this clinical situation is, "does the patient have PV or ET?"; a patient cannot have both. Unfortunately, I encounter this situation too often in my clinical practice. There appears to be a curious but dangerous belief in the medical community that ET is a more sero...
What treatment would you provide for a patient with bilateral synchronous locally advanced cT4dN0 TNBC and cT1b ER+ HER2+ breast cancer?
Yes, the TNBC seems to be locally advanced and being T4d, would qualify for the KEYNOTE-522 regimen. The HER-2 positive cancer is small and clinically lymph node negative, so upfront surgery followed by adjuvant anti HER-2 therapy based on APT trial would be reasonable. But since the patient would h...
Would you give anthracycline chemotherapy to a patient with HR+, HER2 negative inflammatory breast cancer who has history of cardiomyopathy with LVH and moderately reduced EF but most recent echo shows improvement to normal or near normal ejection fraction?
This is a tricky one. The main question is not what the current LVEF is, in my opinion. While it is reassuring to have a normal EF, comorbidities and/or prior cardiac disease is where the permanent damage of anthracyclines come into picture. Therefore, how safely can we give anthracycline based regi...
Would you offer adjuvant chemotherapy to a patient with T3N0M0 NSCLC if the reason for the T3 stage was due to multiple tumor nodules in the same lobe?
I discuss and offer adjuvant chemotherapy to these patients recognizing the fact adjuvant chemotherapy recommendations are not solid in this specific subset of patients. Based on the 8th TNM staging system they would have an overall stage of IIB which means they still have a significant risk of dise...
How would you approach treating patients with RA refractory to cDMARDs and a prior history of MALT lymphoma?
If the concern is the risk of recurrence of lymphoma in a patient with RA requiring DMARD therapy, particularly biologic DMARD therapy, rituximab has not been associated with recurrence or even new onset lymphoma. Rituximab is a highly efficacious biologic DMARD for seropositive RA. This is consiste...
For patients with early stage T1/T2 N0 low rectal cancers who are not candidates for transanal surgery and decline APR due to ostomy, would you offer chemoRT followed by surveillance or chemoRT, then a course of chemotherapy followed by surveillance?
This rectal cancer patient obviously has very limited options since transanal surgery and APR are off-the-table. In our clinic, we have similar situations from time to time but most of the time is that the patients who have T3 or N+ rectal cancer decline an APR. Since the patient has active tumor in...