Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
What is the preferred initial therapy for T-cell lymphoblastic lymphoma in non-AYA, non-elderly adults?
In my opinion, there is no single best choice in this situation, but there are several reasonable options. Given how rare this disease is, I think physician comfort with a specific regimen is arguably the most important characteristic. Any attempt to identify an approach that yielded the best long t...
How do you discuss use of tamoxifen in your stage I breast cancer patients who are > 80 years old weighing in risk of VTE with benefit from adjuvant treatment?
The risk of both thrombotic events and endometrial cancer are age-dependent in general - much of this information is best interpreted from the prevention literature, where the numbers are larger, and the impacts of co-morbidities and concomitant medications are less. With tamoxifen use, both the abs...
What is your treatment approach in metastatic breast cancer with osseous metastases resulting in significant cytopenias?
Bone marrow metastases is not uncommon in metastatic breast cancer but, fortunately, it rarely causes dramatic cytopenias. So, if we come across a patient with cytopenias, we first perform a bone marrow biopsy to confirm the cause. If it is confirmed that metastatic breast cancer is the cause, then ...
Do you have any concerns about using checkpoint inhibitors in a patient with myeloma who has a second malignancy?
This is thankfully, a relatively rare occurrence, but one that still occurs. Either a second solid-tumor malignancy that seems to be related to antecedent high-dose melphalan and/or lenalidomide, or just the misfortune of developing a second cancer from other risk factors such as smoking.In short, f...
What alternative regimens would you consider to neoadjuvant TCHP in setting of national carboplatin shortage for locally advanced HER2+ breast cancer?
In TRAIN-2, hospitals were allowed to use split dose carboplatin AUC 3 on days 1, 8 for 9 q3wk cycles and the pCR rates and outcomes were the same as the FEC treated group. That could be an option if you are getting limited carbo resupply on a regular basis. WSG ADAPT THP looked good for ER-HER2+ di...
Does the presence of ductal adenocarcinoma change how you risk stratify or treat patients with localized prostate cancer?
Ductal adenocarcinoma (DAC) of the prostate is a distinct, but rare (< 1%) subtype of prostate adenocarcinoma. DAC originates from primary periurethral prostatic ducts or in the peripheral prostatic ducts. Because of its predominantly periurethral location, it may present with hematuria, urgency, an...
Would you consider TKI discontinuation in a patient who has negative BCR transcripts on Bosutinib?
Yes, I would certainly consider it provided they meet the criteria. Those criteria would be no different than for the other TKI. It is generally considered that the expectations are the same for all TKIs (with more patients eligible with second generation TKI than with imatinib). Most of this is ext...
When you send for molecular studies for polycythemia vera, what are the mutations that predict increased cardiovascular risk?
This is a very prescient question since arterial and venous thrombosis are frequent events in MPN patients who have polycythemia vera (PV) and these events can precede the diagnosis of PV by several years. Most importantly, we also now know that just having a JAK2 V617F mutation without any clinical...
What chemotherapy regimen would you offer a stage III pMMR rectal adenocarcinoma agreeable to TNT but with significant underlying neuropathy?
It depends on many factors. First, the location of the rectal tumor. Second, other high-risk features - N2 nodes, threatened MRF, etc. Is the patient a surgical candidate? How old is the patient and what other co-morbidities, etc?
Do you continue ADT/Lupron in all patients with castrate resistance prostate cancer?
It is recommended to continue ADT in patients with castration-resistant prostate cancer. Some mechanisms of castration-resistance include upregulation of androgen receptors and autocrine testosterone production, so a castration-resistant cancer is not necessarily a "hormone resistant" cancer.