Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
When (if ever) do you check for anti-platelet antibodies for workup of thrombocytopenia?
Routinely available anti-platelet antibody tests have a sensitivity too high and specificity too low to be of much clinical use. A patient's response to first line therapy (steroids or IVIg) is most telling and if there is no response, a bone marrow is warranted as it would be atypical for ITP. Ther...
What duration of ADT + abiraterone do you recommend prior to initiation of HDR brachytherapy followed by EBRT for very high risk localized cT3bN0 prostate cancer?
This is a short answer (for me) given the lack of data to support brachy boost in T3b disease in a randomized trial.The only randomized multicenter trial comparing dose-escalated EBRT to brachy boost is ASCENDE-RT. They specifically excluded T3b patients (see supplementary content for all exclusion ...
Would you offer adjuvant therapy for poorly differentiated adenocarcinoma of the galbladder s/p R0 resection with negative nodes?
We would offer adjuvant chemotherapy to this patient based on data from the BILCAP study. Final results are still to be published in a peer reviewed journal. This study enrolled patients with biliary malignancies who were randomized to adjuvant capecitabine vs. observation following resection. 18% o...
What factors do you consider when choosing adjuvant treatment for resected (R0) gallbladder carcinoma with positive nodes?
There is sparse data directing the best adjuvant treatment plan for R0 resected Gallbladder Cancer with positive lymph nodes. Long term outcomes are poor even for patients who undergo a complete resection. Interestingly, the patterns of recurrence favor distant sites of disease over locoregional rec...
How would you adjust the steroid dose for steroid-induced psychosis in a patient being treated for secondary HLH with the HLH-94 protocol?
If disease status allows weaning, we slowly wean per recommendations in HLH94. If they need steroids because of significant hyperinflammation that is damaging, then we add risperidone, which generally works very well.
How would you adjust the steroid dose for steroid-induced psychosis in a patient being treated for secondary HLH with the HLH-94 protocol?
If disease status allows weaning, we slowly wean per recommendations in HLH94. If they need steroids because of significant hyperinflammation that is damaging, then we add risperidone, which generally works very well.
Given recent OS data from the OlympiA trial, would you offer adjuvant olaparib to a BRCA+ patient with pT1bN0 TNBC?
I would not, as those patients were not included in OlympiA.
Would you continue pembrolizumab in a patient with BCG-refractory NMIBC with CIS who has a negative surveillance cystoscopy (including random biopsies) but positive urine cytology?
More important priority at this point is to evaluate the positive cytology. If the random biopsies were done with white light cystoscopy only, I would consider blue light and repeat biopsies and would also evaluate the upper tracts and prostatic urethra.
How long would you continue trastuzumab for a patient with metastatic HER2+ esophageal adenocarcinoma whose tumor has achieved CR with FOLFOX + trastuzumab and has been disease-free for nearly 3 years?
This is an important question and one that we are thankfully much more likely to have to address than ever before. I think that slightly more contemporary iterations of this question can be asked for a patient with a Her2 positive, PD-L1 CPS >1 tumor who has received pembrolizumab/trastuzumab and FO...
Is there still a role for mTOR inhibitors in metastatic RCC in the immunotherapy/TKI era?
Practically all my patients with metastatic clear cell RCC will receive an mTOR inhibitor at some time during their treatment course unless they achieve durable CR with early therapy lines. It is a plausible pathway to target, often well tolerated, and very rarely (one in hundreds) may produce durab...