Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Do you offer consolidative thoracic radiation for oligometastatic NSCLC following upfront immunotherapy?
Yes, I do offer consolidation in patients with oligometastatic lung cancer after immunotherapy. Like @Dr. First Last, often these patients are referred to me at "oligoprogression," when one lesion progresses (often the primary or largest site), but most minor lesions appear to be under control. The ...
In a patient with cardiac light chain amyloid who has significant heart failure symptoms, including inotrope dependence at presentation, how much clinical benefit does treatment provide?
In patients with cardiac light chain (AL) amyloidosis who present with significant heart failure symptoms and inotrope dependence, the clinical benefit of treatment is a complex and nuanced issue. This scenario often reflects an extreme end of the disease spectrum. Historically, patients with advanc...
In a patient with cardiac light chain amyloid who has significant heart failure symptoms, including inotrope dependence at presentation, how much clinical benefit does treatment provide?
In patients with cardiac light chain (AL) amyloidosis who present with significant heart failure symptoms and inotrope dependence, the clinical benefit of treatment is a complex and nuanced issue. This scenario often reflects an extreme end of the disease spectrum. Historically, patients with advanc...
In patients with inflammatory arthritis (RA, psoriatic arthritis) and a history of MGUS are there any concerns regarding use of biologics?
There is no absolute contraindication to any particular biologic used to manage active RA in a patient with MGUS. The literature does point out a small potential risk associated with tocilizumab in terms of development of myeloma influenced by the IL-6 pathway (and I would tend to extend that potent...
How do you approach cisplatin dosing for locally advanced head and neck SCC in HPV-positive and HPV-negative patients?
Weekly cisplatin 40 mg/m² is not yet considered equivalent to high-dose cisplatin 100 mg/m² every three weeks, and high-dose cisplatin remains the preferred regimen for both HPV-positive and HPV-negative locally advanced head and neck squamous cell carcinoma. However, weekly cisplatin is an acceptab...
How do you treat encapsulated papillary carcinoma of the breast after lumpectomy with negative margins?
Encapsulated papillary carcinoma behave like DCIS and we use the same principles as we would use for managing DCIS.
Should our selection for neoadjuvant chemotherapy in ovarian cancer patients change in light of COVID-19?
I see this as a two-pronged question where the response may vary based on the specific clinical situation, circumstances of the hospital, and status of the epidemic locally and regionally, along with available resources associated with the rapidly evolving COVID-19 pandemic. There is no question pri...
While using bridging therapy prior to CAR-T cells in myeloma, if possible, do you target a certain response prior to proceeding with cell infusion?
While CAR-T cell therapy was, of course, first studied and shown to be highly effective in heavily pretreated patients with active disease, experience and newer data show the following themes: CAR-T cell therapy in earlier lines of therapy appears to lead to more durable responses. Lower disease bu...
While using bridging therapy prior to CAR-T cells in myeloma, if possible, do you target a certain response prior to proceeding with cell infusion?
While CAR-T cell therapy was, of course, first studied and shown to be highly effective in heavily pretreated patients with active disease, experience and newer data show the following themes: CAR-T cell therapy in earlier lines of therapy appears to lead to more durable responses. Lower disease bu...
What is the role of adjuvant radiation therapy for stage III melanoma in the era of adjuvant Opdivo?
I think the role of adjuvant radiotherapy in stage III cutaneous melanoma is difficult to define at this time (June 2019). To be clear, the TROG trial mentioned above showed that adjuvant lymph node basin radiotherapy after therapeutic lymphadenectomy can decrease the chances of lymph node basin dis...