Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How do you define an adequate EBUS when staging NSCLC?
Important question. There is a high degree of variability in the diagnostic performance of EBUS based pretest probability of disease, physician experience and skill, quality control, and evaluation skills of the cytopathologist. Nice consensus guidelines from CHEST was published a few years back det...
Are there any special considerations when treating a patient with anal cancer who has poorly managed HIV/AIDS?
In the early days of AIDS, prior to the development of HAART, standard chemoradiation ("Nigro") was very poorly tolerated, and it was necessary to omit or dose-reudce the mitomycin, and many patients could not tolerate the full dose of radiation, stopping treatment early because of toxicity. Outcome...
Is there a role for hydroxychloroquine for secondary prevention in patients with APS without SLE?
There are no prospective trials to answer this question. In one cross-sectional study (Erkan et al., PMID 12154210) there was a suggestion of a protective effect of hydroxychloroquine. However, patients were also on aspirin and it may be difficult to sort out which of these agents had the protective...
How do you explain the benefit of endocrine therapy after bilateral mastectomies in early stage breast cancer for a postmenopausal woman?
First of all, all breast cancer is considered to have seeded systemic mets. Also, early is a concept mainly for surgery and radiation while it is important to remember that single cell that became malignant took 7-10 years to reach 1 cm stage if ER positive, and it is to be presumed that some cells ...
When would you treat patients with esophageal adenocarcinoma with neoadjuvant chemotherapy alone such as detailed in the UK MRC OE05 trial?
This is an excellent question with no clear data to provide a direct answer. I think we all acknowledge a) that pre-operative chemotherapy is easier to administer than post-operative chemotherapy and that b) there is zero biological rationale to take the same chemotherapy and split it up before and ...
What is your approach for an RA patient with lung cancer who is starting immunotherapy?
How to manage the patient depends on how well controlled their RA is at the start of therapy and what kind of medication regimen they are on for their RA. If they are on csDMARDs and are stable we usually continue the csDMARDs with immunotherapy unless there is an objection with the oncologist (or i...
How do you manage the development of neuropathy in patients receiving bortezomib for multiple myeloma?
Bortezomib and thalidomide cause the bulk of the neuropathy in myeloma patients worldwide, although thalidomide is rarely used in the U.S. because of more effective immune modulating drugs (IMiD's) available such as lenalidomide and pomalidomide. Pre-existing peripheral neuropathy is the biggest ris...
How do you manage the development of neuropathy in patients receiving bortezomib for multiple myeloma?
Bortezomib and thalidomide cause the bulk of the neuropathy in myeloma patients worldwide, although thalidomide is rarely used in the U.S. because of more effective immune modulating drugs (IMiD's) available such as lenalidomide and pomalidomide. Pre-existing peripheral neuropathy is the biggest ris...
How do you approach management of limited stage SCLC in a patient with idiopathic pulmonary fibrosis?
I've seen a few patients with IPF and small cell. The concern is always that these patients have an underlying pro-inflammatory lung condition that makes them more prone to pneumonitis. My preference in this specific group is to give and complete chemotherapy first and then restage the patient. Sinc...
How do you approach patients with advanced resectable basal cell carcinoma for possible use of hedgehog inhibitors?
Dear Dr. @Dr. First Last, we avoid hedgehog inhibitors in our practice due to several side effects. For head and neck BCC, our experience with first line checkpoint inhibitors has been great in reducing the tumor burden. The patients have not gone to surgery so far as was planned before due to the r...