Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How do you treat locally advanced choriocarcinoma of the urinary bladder?
This is a very rare site and a rare subset of germ cell tumor. I assume the pathology has been reviewed and full scans including ultrasound of testes if a male and HCG/AFP have been performed. Is the patient in the typical age range for germ cell tumors? If this is confirmed and the patient has a ty...
Is there a role for endocrine therapy alone in patients with metastatic HR+, HER2+ breast cancer after all HER2 directed therapies have been used?
There is no clear evidence specifically for this question, but the extrapolation of data from trials and general experience would predict a low chance of benefit with endocrine therapy alone. Growth factor signaling, particularly driven by HER2, is associated with resistance to endocrine therapy as ...
What is the maximum cumulative anthracycline dose you would administer in a patient with metastatic soft tissue sarcoma who is asymptomatic with good disease control?
It depends. The often-cited 450 mg/m2 cumulative lifetime dose of doxorubicin refers to an increased risk of cardiac toxicity in patients who received bolus doxorubicin (in contrast to a 48-72 hour continuous infusion) without a cardio-protective agent. We typically do not exceed this amount in one ...
How do you treat a low-grade B-cell lymphoma with plasmacytic differentiation (Waldenstrom's) confined to the CNS?
This is a rare complication of WM called Bing Neelapu syndrome. It is hard to find a standard of care. Patients tend to have shorter responses to standard therapies such as HD MTX based regimens. Ibrutinib has shown long-term responses (Castillo et al., PMID 30523119).
How would you approach therapy for a SMARCA4-deficient undifferentiated sarcoma with isolated involvement of a mediastinal lymph node?
How do you approach a patient with metastatic urothelial carcinoma who has progressed on maintenance avelumab?
This patient would be in the 3rd line so options include Enfortumab vedotin (based on EV-201, cohort 1, published data, and EV-301 press release) or Erdafitinib (if FGFR2 or FGFR3 activating mutation or fusion based on BLC2001 trial published data) or clinical trial. Outside the US, without access t...
Would you recommend stem cell transplant or gene therapy for a patient with CML and sickle cell disease currently on imatinib with worsening anemia?
That's a great question. The first question to figure out is what is the status of the CML? If the patient is in a molecular remission on imatinib, I think it's important to understand why the patient has worsening anemia and do a work up. If the patient has anemia due to the TKI, can consider dose ...
What treatment would you initiate post-operatively for patients with de novo metastatic follicular thyroid CA requiring laminectomy for cord compression?
I would do RAI if the total body iodine scan is positive. TKIs are indicated in cases that are RAI-refractory. The patient may also require post laminectomy XRT.
Would you offer, and what data would support, the use of an FGFR inhibitor in FGFR3 mutated anaplastic thyroid cancer?
With the lack of effective treatment options for ATC except for BRAFV600E pos subset, every patient should have extended panel NGS and enrolled in trials. With FGFR3 mutation, I would definitely favor enrolling the patient in one of the biomarker (FGFR fusion/mut pos)-specific clinical trials.
Would you use a platinum containing regimen such as docetaxel + carboplatin for an aggressive ER+ breast cancer in a patient with a deleterious mutation in ATM?
We do not have any data on ATM germline mutation carriers in regards to platinum use. Therefore, the decision to use platinum should be made independently from the ATM mutation.