Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
What is your preferred second line of treatment after progression on cisplatin/gemcitabine for advanced or metastatic cholangiocarcinoma?
After progression on the front-line standard of gemcitabine and cisplatin (ABC-02, Valle et al. NEJM 2010), there is not an established second-line standard of care. There are several small prospective studies as well as some retrospective data that are indeed conflicting regarding the true efficacy...
Is day 43 cisplatin 100mg/m2 needed after completion of RT in case of a delay related to neutropenia for locally advanced head and neck cancer?
Based on the retrospective post hoc analysis from RTOG 0129, two cycles of HD cisplatin in the accelerated fraction radiation treatment arm and two cycles of HD cisplatin in the standard fraction radiation arm were equivalent to 3 cycles of HD cisplatin when administered with RT. (Nguyen-Tan et al.,...
How would you manage a patient with p53 mutated MCL who has progressed after a BTKi and CAR-T with a CD20 negative clone?
Venetoclax + CD19 or CD22 mab if available
How would you manage a patient with p53 mutated MCL who has progressed after a BTKi and CAR-T with a CD20 negative clone?
Venetoclax + CD19 or CD22 mab if available
Would you ever choose FOLFOXIRI over FOLFOX for high risk Stage III colon adenocarcinoma with multiple adverse prognostic features?
We are frequently confronted in the clinic with a patient with "high risk" stage 3 colon cancer, most commonly with multiple positive lymph nodes. While our gut reaction might be to treat "aggressively", there are no data supporting FOLFOXIRI in the adjuvant setting. In fact, several adjuvant studie...
Do you routinely offer ovarian suppression in addition to aromatase-inhibitor in premenopausal patients under 50 with an intermediate oncotype score (11-25)?
The TAILORx trial showed that endocrine therapy was noninferior to chemoendocrine therapy in the primary endpoint of invasive-disease free survival among patients who had a recurrence score between 11-25. However, an exploratory subgroup analysis showed a significant interaction between chemotherapy...
How do you approach treatment of sub-total resected ZFTA fusion ependymoma after radiation therapy in a young adult?
Thank you for asking.ACNS0831 has shown that there is no benefit of adjuvant chemotherapy in patients with incomplete resection. This was based on a comparison between ACNS0121 where patients did not receive any chemo after XRT and ACNS0831 where all patients with residual received adjuvant chemothe...
Is there any value to getting a bone marrow biopsy at the time of biochemical relapse in multiple myeloma before switching to a new line of therapy?
Not really. I'm sure there is a patient out there where FISH failed on all the prior bone marrow biopsies and finally, at this relapse, a t(11;14) is discovered which brings BCL2 inhibition into the treatment discussion. Physicians who are less familiar with myeloma will often repeat the bone marrow...
Would you irradiate all borderline suspicious lymph node regions on PET/CT in stage IIA nodular lymphocyte predominant Hodgkin's lymphoma treated with ISRT alone?
ISRT fields for lymphocyte predominant HL when treating without chemotherapy should be more generous in the nodal chain region than if treated with chemotherapy. We conducted a survey of expert lymphoma radiation oncologists published in the IJROBP, which demonstrated some differences in opinion. Ho...
What is the best treatment volume and dose for a marginal zone orbital lymphoma?
It would depend on the location- retrobulbar, conjunctival or lacrimal gland. Imaging, including MRI, helps in evaluating the site of origin and extent of involvement. Some advocate treating the entire orbit for all orbital lymphomas to be comprehensive, as the total dose is low, and this away we av...