Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How would you approach new dermal mets in a patient who recently finished chemoradiation for head and neck SCC?
Dermal mets are M1 disease. Since the patient received chemo, (s)he has a medical oncologist who should manage the case moving forward.
Would you offer XRT as bridging for all patients with limited pre CAR-T disease or as consolidation for only those with residual PET-avidity on day+30 post CAR-T?
There are no studies comparing these 2 approaches. However, given the detrimental outcomes of post CAR-T relapses, I would consider maximizing peri-CAR-T treatments as much as possible as long as the toxicity profile is reasonable, and would not view these 2 approaches as mutually exclusive. I would...
Do you ever repeat screening for acquired von Willebrand in patients with essential thrombocythemia who have high platelet counts and very low risk disease not on cytoreductive therapy?
I generally check on a regular basis (i.e., yearly) to confirm no changes. Obviously, if there is bleeding I would check at that time.
How do you approach patients with node positive sebaceous cell carcinoma of the eyelid for adjuvant chemotherapy and radiation?
Postop RT. I don’t know of data supporting adjuvant chemo.
What would be your approach to first line therapy for patient with metastatic HER2 positive breast cancer with CHF (LVEF <50%)?
I would have cardiology on board and see if EF can be improved with medication. If close to 50% and cardiology feels it's stable/can be improved and can be closely monitored, I may go ahead after coordination with them.
How would you manage a patient with T4N1 duodenal adenocarcinoma by EUS with ampullary invasion that is dMMR?
This is a practical question since Lynch syndrome patients do get upper GI (including duodenal) polyps and cancers. Vos et al., JCO 2021 39.3_suppl.244 The standard of care here would be to do surgery at some point, so any deviation from that would need to be discussed carefully with the patient and...
When do you offer SBRT for a small, slowly growing lung lesion?
I caution ALL radiation oncologists from pulling the trigger on a case like this in a vacuum. Why did I use the word "caution"? It's because we recently studied how often a radiation oncology program is comfortable delivering SBRT w/o histopathological confirmation, and the range was between 0 - 61%...
Would you treat a patient with a pancreatic head mass based on common bile duct brushings suggestive of malignancy, with repeated negative EUS biopsy?
Yes, I would if everything else is consistent with pancreatic cancer.
Are you now using luspatercept as your first choice for anemia management in patients with low-risk MDS otherwise appropriate for EPO initiation, regardless of presence of SF3B1 or ringed sideroblasts?
Only use luspatercept if the patient is transfusion-dependent. FDA approves luspatercept as first-line treatment of anemia in adults with lower-risk MDS (aabb.org). In patients with MDS who are candidates for epo and transfusion independent then epo is still my first choice.
What immunotherapy backbone do you utilize for patients with resectable Stage III melanoma when you offer neoadjuvant therapy?
This is one of the most debated questions in the melanoma community. We personally prefer using single agent anti-PD1 in the neoadjuvant setting based on the results of the SWOG-1801 study. The recently presented data at ESMO 2023 showed a 97% 2-year RFS in patients with complete pathologic response...