Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Would you offer a patient with MMR-deficient colon cancer who underwent surgical resection of metachronous liver metastases "adjuvant therapy"?
In the general population of colorectal cancer patients with upfront resectable liver metastatic disease with low clinical risk, resection followed by a risk–benefit discussion regarding adjuvant chemotherapy or surveillance is appropriate. Fluorouracil-based chemotherapy compared to observation has...
Do the level of positive lupus anticoagulant titers correlate with the risk of VTE?
The lupus anticoagulant test is either positive or negative. It’s not reported out at a titer. The test needs a two-step confirmation, the first being the addition of mixed plasma to rule out a factor deficiency and the second confirmation being the addition of phospholipids and showing normalizatio...
Do you recommend routinely getting periodic 24-hour urine monoclonal protein study for patients with active multiple myeloma?
In short, no. I like to perform at the time of diagnosis and then at key points in the patient's journey if it was grossly abnormal (at the time of a bone marrow biopsy, for example). Patients definitely do not enjoy it. It does allow for IMWG response assessment, which is mandated for patients on t...
How do you approach a patient with discordant breast cancer risk prediction scores for prevention?
It's not uncommon to come across discordant lifetime breast cancer risk estimates between routinely used risk assessment models such as Gail, TC V8.0, Claus, and CanRisk. These models differ widely in the risk elements, ability to incorporate results from germline panel testing/PRS, and their streng...
Do you consider downstaging neoadjuvant cemiplimab for borderline resectable CSCC in order to facilitate surgical resection?
The answer is yes, since the publications of the neoadjuvant cemiplimab study in the NEJM (Gross et al., PMID 36094839/). However, this is a change of standard of care, not yet vetted in the NCCN guidelines (Guideline SCC4), nor FDA approved for this indication. Thus, off label cemiplimab or pembrol...
Can a patient with MDS have ring sideroblasts in the absence of mutation such as SF3B1?
Absolutely! While MDS with ringed sideroblasts and SF3B1 denote a special subset of MDS with ringed sideroblasts, they can also be seen with other spliceosome mutations (SRSF2, U2AF1 or ZRSR2). In one analysis, only 1.5% of patients with MDS with low blasts and ringed sideroblasts lacked a spliceoso...
What scenario would prophylactic Tocilizumab be considered to prevent Ipilimumab+Nivolumab (immunotherapy) induced toxicity in malignant melanoma?
Currently, there is no indication for prophylactic Tocilizumab with the data that is available. As a matter of fact, Tocilizumab is off-label for the treatment of immunotherapy-related toxicities (it’s indicated for the treatment of CAR-T-induced toxicities and cytokine release syndrome, though not ...
Would you be willing to give definitive chemo-radiation and chemotherapy to a MSI-stable T2N0 low lying rectal cancer in a young healthy patient who wants to avoid surgery?
More likely to recommend total neoadjuvant therapy hoping for induction of complete clinical response. In our hands, on average, we are able to conserve the rectum in about 55% of treated patients with excellent rectal function and a regrowth rate of less than 10%. Local excision will not address th...
Are you routinely using neoadjuvant cemiplimab for cutaneous squamous cell carcinoma of any site?
No
Would you offer a 2nd generation anti-AR or abiraterone after progression on ADT in patients with metastatic AR+, HER2 expressing salivary gland carcinoma?
Due to the rarity of the condition, there is limited data that strongly support any intervention in this situation. However, I see 2 potential targets in this case: HER 2 and AR. It would be helpful to know what these patients have been treated with before. If only AR was targeted, adding a HER2 age...