Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How would you approach a patient with solitary plasmacytoma with an FLC ratio >100, but a negative bone marrow biopsy and negative PET-CT?
Are we to assume the Ca, Hgb, and creatinine are normal? Completing the testing with 24 hr UPEP with immunofixation is important. With a free light chain ratio of >100, there is generally proteinuria. If 24 hr urine total protein is 1 g/day or more, I would do a kidney biopsy to document light chain...
How should PARP inhibitors be incorporated into clinical practice in later line/maintenance of platinum-sensitive ovarian cancer for PARP inhibitor-naïve patients?
Personally, if I have a PARPi naïve recurrent platinum-sensitive patient, I would have no hesitation in treating them as we did in these trials. The OS data and FDA action on the prior indications, in my opinion, was a reckless statistical exercise and potentially harmful to patients.
What outcome data do you view as most impactful to make treatment decisions regarding the use of PARP inhibitors in later line or recurrent ovarian cancer?
The crossover makes the OS data very hard, if not impossible, to interpret. The findings were not that parps for platinum sensitive maintenance for non-BRCAm were detrimental -- it was that they did not seem to show OS benefit. Certainly, treatment free intervals and quality of life are extremely im...
Would you use the MIPSS-PV risk scoring to decide in decision making for cytoreductive therapy in PV?
I think the MIPSS-PV is helpful in understanding predicted overall survival and appreciating the risk of progression, the decision to cytoreduce is still routed in the classic thrombosis risk model of age plus thrombosis history. I would certainly recommend getting an NGS panel to better understand ...
Have you encountered acute kidney injury after starting eltrombopag for aplastic anemia as part of triple immunosuppressive regimen with ATG and cyclosporine?
No, I have not. Of course, cyclosporine is intrinsically nephrotoxic and is the likely candidate. Sometimes, ATG will result in renal issues as well although less frequently.
Do you ever initiate on degarelix and then switch to leuprolide for patients with prostate cancer and cardiac risk factors receiving ADT?
I do not believe that there is a major differential in cardiotoxicity between LHRH antagonists and agonists. The key issue is metabolic syndrome associated with long-term androgen deprivation. Randomized trials have not shown convincing evidence of a difference in cardiotoxicity between agonists and...
How do you sequence HER2-therapy in HER2+ biliary tract cancer with the positive results of tucatinib + trastuzumab and zanidatamab in phase 2 studies?
Would you offer ultrahypofractionated 5 fraction breast radiation to a patient with lupus?
Favor partial breast over whole breast if feasible.APBI or IMPORT LOW volume and FAST-Forward dose of 26 in 5.
How do you approach post-transplant maintenance for patients with high-risk myeloma?
I'm migrating the discussion from another thread ("Top Takeaways from ASCO 2023") here, mainly because the premise of this question is based on new data about KPd maintenance in high-risk patients presented by Dr. Nooka and colleagues as an oral presentation this past ASCO 2023.@Dr. First Last's ins...
When, if ever, would you re-challenge with immunotherapy for patients with metastatic RCC?
Checkpoint inhibitors combinations (IO/IO and TKI/IO) are the most likely way for a patient to experience a durable response. However, we need better treatment options for patients who are experiencing disease progression to these therapies. A number of new immune treatments are currently in clinica...