Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How do you approach balancing the potential risk of worsening actinic damage and maintaining CTCL clearance in patients treated with nb-UVB?
NB-UVB continues to be the most effective skin directed therapy for patch MF. I try to use it as much as possible as monotherapy, or commonly in combination with retinoids for treatment and maintenance of early-stage disease. In patients with severe solar damage, I may continue phototherapy adding l...
How do you choose between peginterferon and anagrelide for ET patients if hydroxyurea-intolerant?
This is largely dependent on the patient. I generally prefer to use peginterferon, however, have a discussion with the patient outlining the options. Anegrelide isn't well tolerated in general, but peginterferon can also have negative side effects and may be too costly.
How do you choose between peginterferon and anagrelide for ET patients if hydroxyurea-intolerant?
This is largely dependent on the patient. I generally prefer to use peginterferon, however, have a discussion with the patient outlining the options. Anegrelide isn't well tolerated in general, but peginterferon can also have negative side effects and may be too costly.
How would one approach concomitant diffuse large B cell lymphoma and fibrotic phase myelofibrosis?
This is a tough case without perfect answers. I will make some assumptions to answer and say that the DLBCL likely takes priority here as it's more likely to impact patient survival in the short term. Depending on the stage/risk of both diseases that will inform how these are managed and if the DLBC...
How would one approach concomitant diffuse large B cell lymphoma and fibrotic phase myelofibrosis?
This is a tough case without perfect answers. I will make some assumptions to answer and say that the DLBCL likely takes priority here as it's more likely to impact patient survival in the short term. Depending on the stage/risk of both diseases that will inform how these are managed and if the DLBC...
Would you consider using luspatercept for a patient with MDS with anemia refractory to ESA/HMA, that has a SF3B1 mutation but without ringed sideroblasts?
A trial of luspatercept would be a reasonable option for this patient. While the phase III studies supporting the use of luspatercept do not represent this patient (MEDALIST Fenaux et al., PMID 31914241 and COMMANDS Platzbecker et al., PMID 37311468), the presence of an SF3B1 mutation does appear to...
Would you consider using luspatercept for a patient with MDS with anemia refractory to ESA/HMA, that has a SF3B1 mutation but without ringed sideroblasts?
A trial of luspatercept would be a reasonable option for this patient. While the phase III studies supporting the use of luspatercept do not represent this patient (MEDALIST Fenaux et al., PMID 31914241 and COMMANDS Platzbecker et al., PMID 37311468), the presence of an SF3B1 mutation does appear to...
What are magic mouthwash alternatives that you would recommend?
Many of our patients will make their own DIY MMW per Phil's My Pharmacist (YouTube) instructions -- uses benzocaine/Cepacol lozenges -- they say it's much more effective than the compounded one from the pharmacy. It is also more economical.If the majority of bothersome mucositis is in the oral cavit...
Do you routinely offer PARP inhibitor maintenance therapy to germline BRCA1/2+, FIGO stage II serous ovarian carcinoma patients after adjuvant chemotherapy?
We are not offering PARPi maintenance in early stage disease at this time. We are in line with the data showing benefit in advanced stage disease. While the data are compelling, you must remember that that these medications 1) have side effects including risk of MDS and 2) can be used in the recurre...
What is your treatment approach for a MSS metastatic colorectal cancer patient who has progressed on FOLFOX and FOLFIRI?
If the patient is RAS/BRAF wildtype, then I would pursue anti-EGFR antibody-based therapy. If the patient has KRAS mutant colorectal cancer and continues to have a good performance status, then I would pursue clinical trials if possible. Many of the clinical trials in this space are phase I or phase...