Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Outside of a clinical trial, what is your preferred first-line therapy for a fit patient with de novo metastatic spindle cell sarcoma?
Hard to answer definitively without knowing the location of primary and better clinical and/or pathology clarification. Assuming a better definition of path is not possible, I would favor Doxorubicin (75 mg/m2) plus Ifosfamide (10 g/m2 divided into 4 or 5 daily doses). Additional information may wel...
How would you treat metastatic squamous cell carcinoma arising from a mature cystic ovarian teratoma?
There is a lack of established guidelines to treat patients with metastatic squamous cell carcinoma arising from a mature cystic ovarian teratoma (MCT-SCC). In the absence of a clinical trial, this patient should be offered platinum-based chemotherapy. Next generation sequencing (NGS) should also be...
What chemotherapy would you recommend for a patient with Ewing Sarcoma who has relapsed after being initially treated with vincristine/doxorubicin/ifosfamide?
If the relapse occurred less than 2 years off original chemotherapy, I would use vincristine, irinotecan, and temozolomide. If more than 2 years off, go back to the original regimen. In either case, consider ifosfamide-etoposide if failing to get a CR at the point of maximum response.
What is your preferred ET treatment for patients intolerant/resistant to hydroxyurea?
In patients without contraindications, I strongly consider pegylated interferon. For patients that are older than 70, I consider oral busulfan. If these two options aren’t applicable to the patient, then anagralide is a good choice. You are correct that it is not always easy to obtain, and that has ...
How do you determine whether to treat a young adult with stage IA Hodgkin Lymphoma with the adult or pediatric treatment paradigm?
There is a long history of pediatric protocols for HL differing somewhat from the adult ones, but not much biologic rationale to support this, as the disease in young adults is biologically the same as in pediatric patients. Side effects of RX may of course differ, particularly with regards to RT an...
What would you recommend for an elderly patient (> 80 year old) with resectable pancreatic cancer?
This is an excellent question and not just for the elderly population cited, but as a global query. There are no randomized trials that suggest resectable patients have improved survival. On the other hand, even with resection, more than 90% of patients will recur, and adjuvant therapy is recommende...
How would you treat an SCLC patient who manifests a bona fide etoposide allergy on cycle two day one?
Perhaps consider desensitizing; other options include trying irinotecan or paclitaxel in place of Etoposide.
For metastatic colorectal cancer, is it possible for the tumor to be mismatch repair proficient at primary site but mismatch repair deficient at metastatic site?
This is a very interesting question, and most of the time we think the MSI/MMR status between the primary site and the metastatic lesion is consistent. However, some studies suggest there could be some inconsistent results in colorectal cancer patient. In a small study with 40 metastatic colorectal ...
Due to the thrombotic nature of COVID-19, should we be discontinuing tamoxifen temporarily in patients with an active infection?
It is not clear (at least to me) what the thrombogenic potential of COVID-19 is, or in what settings it manifests (i.e., hospitalized patient with an increasing O2 required or intubated, in which there are some preliminary reports, versus the asymptomatic or minimally symptomatic patients). It seems...
What is your TKI preference in patients with chronic phase CML on hemodialysis?
When choosing a TKI for patients on HD, it's important to know that TKIs are unlikely to be dialyzed. TKIs are mainly eliminated via the feces with small amounts eliminated by the kidneys. TKIs with the least amount of renal elimination theoretically should be preferred. Nilotinib and bosutinib have...