Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Would you consider using tucatinib in a patient with de-novo metastatic HER2+ HR(-) breast cancer patient with extensive intraparenchymal and leptomeningeal carcinomatosis?
Absolutely. The HER2CLIMB regimen is well known to have good CNS penetration. There is an ongoing trial looking at this regimen in Her2+ leptomeningeal disease (TBCRC049). Given the pacity of studied regimens/data in leptomeningeal disease, this is an excellent option. Other options include T Dx'd -...
How do you manage patients blood pressures while on anti-angiogenic TKIs?
Advise patients to take BP daily, and inform us if the BP is high.
Should all patients with a remote history of immunotherapy, chemotherapy and/or radiation therapy have a baseline TTE regardless of ASCVD risk?
The current ASCVD risk assessment calculators we have available do not contain cancer-specific parameters and thus are inadequate for accurate assessment of a cancer survivor's risk of developing CHF and ischemic heart disease. If patients have received mediastinal radiation therapy or high-dose ant...
How would you manage a patient with stage IV EGFR L858R mutation but with a debilitating drug rash from osimertinib?
I'm assuming that all methods of supportive care and dose reduction have been tried at this point (i.e. even with maximal supportive care, Dermatology referral, and osimertinib reduced to 40 mg PO daily), there is still intolerable rash. This is a difficult situation and there isn't much available i...
During induction therapy for acute leukemia, when do you decide to discontinue the antimicrobial prophylaxis?
Antimicrobial prophylaxis (PPX) during treatment of acute leukemia can take several forms, and it is not always directly associated with blood counts.Fungal PPXDuring induction for AML, there are randomized data supporting posaconazole over fluconazole or itraconazole (Cornely, et al. New Engl J Med...
During induction therapy for acute leukemia, when do you decide to discontinue the antimicrobial prophylaxis?
Antimicrobial prophylaxis (PPX) during treatment of acute leukemia can take several forms, and it is not always directly associated with blood counts.Fungal PPXDuring induction for AML, there are randomized data supporting posaconazole over fluconazole or itraconazole (Cornely, et al. New Engl J Med...
Is there a role for chemotherapy for asymptomatic Well-Differentiated Papillary Mesothelioma or Multicystic mesothelioma?
No role for chemotherapy, in my opinion. These presentations should be handled by observation if asymptomatic, or surgery when symptoms start to appear. Treatment should be debulking with or without hyperthermic perfusion with local chemotherapy.There are many case reports of chemotherapy treatments...
What is the optimal dosing schedule and duration of zoledronic acid in breast cancer patients with bone metastases?
The short answer is YES, a monthly schedule x 1 year, followed by a dose every 3 months seems to be a reasonable standard of care. However, additional research is needed to answer the question about optimal duration of therapy and dose/schedule in years beyond the first two years of therapy.
How do you utilize immunoglobulin testing to affect treatment decisions in patients with myeloma?
Most of the time, I correlate the type of Ig the patient has with the serum M protein and Free light chain to see if they are responding or progressing (most of the time it will correlate); the only exception is patients who are known with IgA type; most of the time the serum M -protein might not co...
How do you utilize immunoglobulin testing to affect treatment decisions in patients with myeloma?
Most of the time, I correlate the type of Ig the patient has with the serum M protein and Free light chain to see if they are responding or progressing (most of the time it will correlate); the only exception is patients who are known with IgA type; most of the time the serum M -protein might not co...