Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How would you treat an adult patient with T-cell lymphoblastic lymphoma with FGFR1 rearrangement and co-exisiting myeloproliferative neoplasm?
This is a rare condition only recently recognized as its own diagnostic entity by the WHO as part of a larger family of disorders referred to not-concisely as "myeloid/lymphoid neoplasms associated with eosinophilia and rearrangement of PDGFRA, PDGFRB, or FGFR1 or with PCM1-JAK2" (Arber et al., PMID...
Would you consider using immunotherapy in mismatch repair proficient metastatic colorectal cancer with PDL1/PDL2 gene amplification?
This is a very interesting question with limited data. PD-L1 amplification is rarely seen in the clinic. The largest study to date (with 118 187 tumor sample) suggested 0.7% PD-L1 amplification in all solid tumors with <0.02% in colon or rectal cancers (Goodman et al., PMID 29902298). Interestingly,...
Would you offer neoadjuvant chemotherapy to a patient with high risk non-muscle invasive urothelial carcinoma for whom cystectomy is planned?
Short answer is no in NMIBC. If there is pT3/4 and/or pN+ path Stage at radical cystectomy, would consider adjuvant therapy options, e.g. cisplatin-based chemo or clinical trial.
Is there a role for MRD monitoring in the decision to switch from a triplet regimen to maintenance therapy in transplant-ineligible myeloma patients?
There is no role for MRD monitoring in the decision to switch from 3-drug therapy to maintenance, yet. First, MRD status is not the only variable to consider. It's ideal to personalize ongoing therapy as high-risk myeloma may require 3-drug therapy to remain in control, and low-risk disease may stay...
For patients with NSCLC with non-classical driver mutation alterations (atypical EGFR, BRAF nonV600E, etc), what resources do you utilize to determine likelihood that tumor will be sensitive to targeted therapies?
Resources to look up information: 1. OncoKB 2. ClinVar 3. The Jackson Laboratory The Clinical Knowledgebase (free version with limited # of genes, subscription required for a larger database)
Would you consider using adjuvant chemotherapy for a patient with anal squamous cell carcinoma with a positive surgical margin after APR done for persistent/progressive disease after chemoradiotherapy?
There is no evidence that postoperative chemotherapy can alter the negative prognostic significance of a positive surgical margin after APR and improve long-term outcomes. Consequently, I would monitor this patient closely and initiate treatment only when warranted by clinical and/or radiographic pr...
How do you decide what induction chemotherapy regimen to use for a patient with locally advanced rectal cancer (cT4N1) receiving total neoadjuvant therapy?
The approach for a locally advanced rectal cancer (cT4N1) requires the consideration of many patient and cancer-specific factors. It is our practice that all new cases of rectal cancer undergo pelvic MRI including the use of rectal contrast to confirm staging with a dedicated assessment of nodal sta...
What is the role of hydroxyurea in variant sickle cell genotypes?
I have had little success using hydroxyurea in my patients with hgb SC disease and at this point in patients with two or more acute visits over 12 months for pain, I am using crizanlizumab as some of the subjects in the phase 2 study on which the drug received FDA approval had SC disease (Ataga et a...
How does presence of MMR deficiency/Lynch syndrome affect your recommendation on peri-operative chemotherapy for high-grade upper tract urothelial cancer?
The presence of MMR deficiency does not really alter my recommendation regarding peri-op chemo for high-grade upper tract UC. Firstly, I don't personally think the MMR deficiency data are ready for prime-time use in chemo-prescribing; I do think this connotes for a higher likelihood of resistance, b...
Should a young adult male patient with Philadelphia-like ALL being treated on the Alliance A041501 protocol and in remission undergo transplant?
I would offer transplant. Ph-like ALL usually carries a poor prognosis and has been associated with worse overall survival and event-free survival compared to patients with other non-Philadelphia positive B-ALL (with approximately 5-year survival of 23% versus 59% according to a study by MD Anderson...