Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How would you approach treatment of metastatic signet cell carcinoma of likely gastrointestinal origin with no primary lesion identified?
I would typically like more information before proceeding. With advanced diagnostics, we have seen the incidence of CUPs fall in recent years but that said, the true CUP still exists.When stated this is "likely GI origin", I assume that there are IHC features consistent with GI origin such as CK7+ b...
How long do you continue treatment with imatinib in a patient with chronic eosinophilic leukemia who achieves remission?
This has not been clearly established. If the patient has the FIP1L1/PDGFR rearrangement, these patients need very low doses for excellent response, typically 100 mg daily. If not, response rates are lower and they usually require higher doses. I would continue therapy indefinitely as TFR has not be...
Do you switch from imatinib to another TKI in patients with chronic phase CML who develop renal insufficiency?
Imatinib has been associated with a decline in GFR. It is not certain (and probably doubtful) that this represents kidney damage. If no other causes can be identified, a change could be appropriate. Bosutinib has been associated with a similar decline so nilotinib or dasatinib might be better option...
How would the development of pneumonitis from pembrolizumab after treatment as per Keynote 522 alter your PMRT recommendations?
If recovered completely, I would proceed with PMRT.
When would you consider tapering glucocorticoids in a patient with ICI-associated myocarditis?
Once troponins start to decrease, I start the steroid taper and follow troponin levels. If they rise, I slow the taper. I also get serial ECGs, esp if there were arrhythmia manifestations of myocarditis. Don't forget to assess for the need for PJP prophylaxis with Bactrim or pentamidine and PPI sinc...
Do you always obtain PSMA PET as initial staging for high risk and very high risk localized prostate cancer patients?
I do obtain a PSMA PET/CT or PET/MRI in all patients with high risk localized prostate cancer. However, when this is not available due to insurance coverage issues or lack of access to PSMA PET, it is still acceptable to stage with bone scan and CT or MRI. I prefer PSMA PET because it has better per...
Would you consider using Breast Cancer Index to make decisions about extending AI therapy in patients who completed 5 years of AI, given recent data presented at SABCS 2022 about validation of BCI in IDEAL trial?
Use routinely.
Do you change treatment for confirmed biochemical progression in patients with otherwise secretory MM even if the M-spike is <0.5 g/dL?
I agree- these decisions should be individualized. However, the reason I posted this comment is to draw attention to the problem which hematologists and oncologists have all but ignored - a huge problem with overtreatment. 30%+ what we do is unnecessary and quite likely harmful. We are not short on ...
In small cell lung cancer with effusion that is negative on thoracentesis twice, do you assume limited stage disease?
Although we know the sensitivity of a single thoracentesis to detect malignant pleural effusion is fairly low (perhaps 65%), effusions in SCLC can sometimes be reactive - if there is any lung collapse, for example. If otherwise limited stage and multiple attempts have been made to rule out malignant...
In the Nebraska/Mayo transplant protocol for perihilar cholangiocarcinoma, do you ever offer prophylactic biliary drainage/stenting to prevent obstruction post-chemoradiation?
We use an ERCP-placed nasobiliary approach to biliary brachytherapy as part of our pre-transplant CRT regimen for patients with peri-hilar cholangiocarcinoma (Murad et al., PMID 22504095). Our technique is described by Deufel et al., PMID 29776892. Patients with baseline tumor and/or comorbid diseas...