Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
In the current myeloma landscape, do you make treatment decisions based on MRD results, either for MRD negativity or MRD resurgence?
Not yet
How do you sequence treatment for a patient following R2 resection of a large extremity leiomyosarcoma who has small lung nodules concerning for metastatic disease, but not yet biopsy proven?
In general R2 resection is not good news. I would first clarify with the surgeon, the barriers to a re-resection. If re-resection is feasible, then perhaps that should be attempted first. This patient is at high risk for local relapse, which ultimately leads to a poor quality of life. If the lung no...
How do you treat primary refractory diffuse large B cell lymphoma in elderly patients with good performance status?
In general, age (by itself) is not a limitation for most of the available therapies for DLBCL elderly patients. Comorbidities and performance status are what drive the decision of what to use as next therapy. I usually recommend all the approved therapies for RR DLBCL. My limit for autologous transp...
How do you treat primary refractory diffuse large B cell lymphoma in elderly patients with good performance status?
In general, age (by itself) is not a limitation for most of the available therapies for DLBCL elderly patients. Comorbidities and performance status are what drive the decision of what to use as next therapy. I usually recommend all the approved therapies for RR DLBCL. My limit for autologous transp...
When can abdominal surgery be safely performed for presumptive ovarian cancer in a patient with recent pulmonary emboli?
In general, the standard approach is to try to wait as long as possible after the thrombotic event, at the very least three months. This may not be possible, we then reduce that time interval to one month. Given the urgent nature of the surgical intervention, one approach is to wait one month and co...
Is it safe to administer cabazitaxel to a patient with mCRPC who developed grade 3 pneumonitis from docetaxel?
In general, the answer is yes, as these are distinct therapies with distinct toxicities. Both are formulated in TWEEN80 solvent and can cause allergic reactions and anaphylaxis, and this is the only adverse event that I would strongly consider avoiding cabazitaxel if this event was experienced in a ...
What is the indication for phlebotomy in compound heterozygous hemochromatosis?
The indication for phlebotomy is proven or strongly suspected iron overload. The likelihood of expression in these individuals is low. An elevated ferritin is often due to reasons other than iron overload such as fatty liver or alcohol intake. I usually do a liver ultrasound in this circumstance. If...
What is the indication for phlebotomy in compound heterozygous hemochromatosis?
The indication for phlebotomy is proven or strongly suspected iron overload. The likelihood of expression in these individuals is low. An elevated ferritin is often due to reasons other than iron overload such as fatty liver or alcohol intake. I usually do a liver ultrasound in this circumstance. If...
Is tamoxifen absolutely contraindicated in pre-menopausal women with Lynch syndrome?
Given a genetic confirmation of Lynch Syndrome, risk reduction surgery should be performed. This is especially true with those Lynch cohorts with MSH6 mutations or MSH2, as these have the highest risk---or even the exclusive presentation with--endometrial cancers. Once the uterus has been removed, t...
How would you approach patients with primary cardiac sarcomas for adjuvant systemic treatment?
Majority of these primary cardiac sarcomas tend to be angiosarcomas or UPS-variants. They inherently have a poor prognosis with high risk of metastases and death. Adjuvant XRT is generally difficult in this location. These also generally affect young individuals with o/w good PS/organ function. So w...