Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How would you treat a patient presenting with de novo metastatic prostate cancer and baseline low testosterone?
By definition, progressive disease despite castrate levels of testosterone is CRPC. This is a very rare situation in the de novo setting, and more likely one may encounter a patient with only slightly low testosterone, which would not be considered CRPC. Patients with de novo metastatic prostate can...
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 do you approach work-up for a patient suspected for monoclonal gammopathy of renal significance for whom renal biopsy is contraindicated?
Not very many reasons that a renal biopsy could not be done, but I would consider doing a bone marrow biopsy if the free light chain ratio was significantly abnormal, i.e. a ratio of 3 or greater. A reminder that in renal failure, both light chains may be elevated, but the ratio in benign processes ...