Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How do you approach the management of GVHD prophylaxis in the setting of severe infection?
GVHD prophylaxis the 1st ~ 3 months after alloSCT is paramount and immunosuppression withdrawal might cause GVHD which can in turn exacerbate or cause infection given the need of corticosteroids to control it. Having said that, case-by-case management is important. As an example, alloSCT using a PTC...
What are your top takeaways from SABCS 2022?
Here are my top 3 presentations (specifically for breast medical oncology) that I would say are most impactful (now or soon), with slides attached. GS3-04 - Capivasertib Phase III (CAPItello-291) Trial – these results will likely change standards for post CDKi progression for HR+/HER2-negative metas...
How do you titrate hydroxyurea in the management of myeloproliferative neoplasms?
It certainly depends on the situation, but for most patients, the default is to start at 500 mg PO daily and make adjustments every 1 to 2 weeks based on the counts to get to the therapeutic targets.
How are you managing patients with recurrent NMIBC with CIS who decline cystectomy with the recent BCG shortage?
https://suonet.org/resources/news/bcg-shortage-addressed-by-urologic-community.aspx
How would you treat margin positive, node positive (pN+) prostate cancer with detectable post-op PSA but negative PSMA-PET after radical perineal prostatectomy?
Ideally, enroll the patient in a clinical trial like NRG GU-008. Off trial, would treat with salvage RT to the prostate bed and lymph nodes with long term (2 years) ADT. You can consider an MRI to see if there's a nodule in the prostate bed to boost, which may be more likely given a positive margin....
How do you manage surveillance imaging for patients with metastatic castration-naive prostate cancer with an initial low PSA?
Low PSA progression is common at the time of radiographic progression in the mHSPC setting, particularly among men treated with potent AR inhibitors. As we recently presented in the ARCHES phase 3 study, while enzalutamide significantly improves rPFS and OS and reduces progression events, among thos...
Would you consider clearing a patient with essential thrombocytosis for a kidney donation?
For brevity, I am assuming that the patient is already medically approved for surgery and organ donation, and I will focus on the clinical significance of the essential thrombocytosis (ET) with regard to both. I am also going to assume that the patient actually has ET, and not masked polycythemia ve...
How would you approach a patient considered to be unfit for cystectomy with recurrent NMIBC refractory to BCG, failed pembrolizumab and unable to do more intravesical Rx?
This seems to be a very difficult scenario, what are the reasons for not being able to pursue intravesical therapies? Nadofaragene firadenovec just got FDA approval, while there have been data with intravesical gemcitabine/docetaxel. We are waiting for the FDA decision on N-803/BCG combo (QUILT-3.03...
Would you consider bone antiresorptive therapy in mCRPC with only 1 lesion per PSMA scan?
This is an important question. One of the best studies to examine this is here:Francini et al., PMID 34292336 from the abiraterone chemo naive mCRPC multicenter cohort study, in which both survival and SRE free survival were improved with the use of bone resorption inhibitors, especially in men with...
How would you treat a patient with chronic phase CML who could not tolerate nilotinib due to G4 thrombocytopenia despite sequential dose reductions?
It depends on various other factors such as the current response and the doses used. I generally work on trying to get the patients to tolerate treatment first and then focus on response. I have used doses of nilotinib as low as 50 mg daily in some patients; this may make the thrombocytopenia more m...