Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Do you routinely offer consolidation RT to sites of previous bulky disease in stage III and IV Hodgkin's lymphoma who have a complete metabolic response on restaging PET/CT following 6 cycles of ABVD?
Update - 1/5/24Three important studies have been published in the last few years which shed light on the role of RT in advanced HL in the setting of a negative interim (and post-chemotherapy) PET-CT.The RATHL trial included 1,119 patients with IIB-IV (or IIA with either bulky disease or at least 3 s...
How do you manage acute keratoconjunctivitis following total skin electron therapy (TSET)?
Institutions approach total skin electron beam therapy (TSEBT) somewhat differently. I generally try to utilize external eye shields as much as possible. If a patient doesn't have active disease involving the eyelids or peri-orbital skin, this obviates the need for internal eye shields which reduces...
How would you approach treatment in a patient with Fanconi anemia and glioblastoma?
This is challenging due to the sensitivity of Fanconi anemia patients to DNA-damaging treatment. I would maximize resection if possible and then treat with radiation, since it is a mainstay of therapy, despite the risk. I would opt for proton radiation if possible to minimize exposure of normal tiss...
Would you offer OFS 5 years out from diagnosis in a young patient whose menses have returned with previously treated IDC?
I would if you are considering extending her endocrine therapy based on clinical risk or other info like BCI testing. If she took tamoxifen alone then I would discuss OFS+AI based on the benefit seen in MA.17 for letrozole x 5 years after tam x 5 years. Shouldn't matter if the menopause is natural o...
What is your frontline treatment of choice for patients with systemic and secondary CNS involvement by DLBCL?
It depends on the intent of treatment, the age, and the PS of the patient. If you are going for a potential curative intent, R-CHOP combined with high-dose methotrexate (R-CHOP-M) - Damaj et al., PMID 26185174, followed by thiotepa-based (thiotepa-BCNU) autoSCT in young, fit patients with chemorespo...
In patients with HTLV-1 associated acute T-cell leukemia, is there any clear benefit of adding antivirals?
There is no virologic rationale for using antivirals to treat HTLV-1-associated malignancies. HTLV-1 is a "transforming" retrovirus that directly causes cancer by oncogene expression. There is no significant "lytic" replication occurring once the cancer has manifested. Antiretrovirals only work with...
What is the appropriate treatment for marginal zone lymphoma of the parotid following surgery?
Definitive radiation therapy is the standard treatment for a patient with an uncomplicated case of localized marginal zone lymphoma of the parotid gland. The CTV would encompass the entire gland and the total dose would be 24 Gy. Occasionally patients will be diagnosed with MZL after parotidectomy, ...
Do you prefer cisplatin or carboplatin in combination with nivolumab per CheckMate 816 for patients with resectable NSCLC?
As a survivor of the cisplatin/carboplatin (i.e., coke/pepsi) wars, I hesitate to jump into this question. I note that in the referenced study (CM 816 Forde et al., PMID 35403841), 72% of the patients received cisplatin based chemotherapy preoperatively, and 28% received carboplatin based preop chem...
How would you approach second line treatment for prostate adenocarcinoma with diffuse neuroendocrine features?
Men with NEPC (histologic evidence of small cell carcinoma) face a poor prognosis and are typically refractory to all hormonal interventions, and in fact transformed NEPC much more typically evolves after potent AR inhibition than present de novo at diagnosis. Autopsy series and biopsy series sugges...
What are your takeaways from the GPRC5D-Targeted CAR-T trial (Mailankody et al. NEJM Sept 2022) and any key differences compared to the BCMA directed products?
I think it is hard to draw too many conclusions given that this is a first in human phase I study with only a small number of patients. What is promising here is that GPRC5D seems to be a good target for myeloma, even among patients with prior exposure to BCMA-targeted therapy. The population in thi...