Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How do you counsel patients referred for abnormal light chain ratio when individual light chains are in normal range?
It appears you are referring to a situation where the uninvolved light chain is quite suppressed and the potentially involved light chain is normal, generating an abnormal ratio. There are other situations such as in CKD where both kappa and lambda light chains will be elevated but the ratio will be...
How would you approach low grade non-invasive urothelial carcinoma arising from seminal vesicle and ejaculatory ducts with invasion into prostate?
Primary urothelial carcinoma of seminal vesicle is extremely rare. There is some skepticism whether this is a true entity. More common is the secondary spread from bladder primary. This can happen as a result of direct invasion through bladder wall or via mucosal spread. Formal is staged as T4 disea...
For patients with metastatic triple negative breast cancer on nab-paclitaxel + atezolizumab who have an ongoing response, are you continuing immunotherapy after the FDA withdrawal of atezolizumab?
Yes, I would consider continuing immunotherapy. We know that the full benefit of immune checkpoint inhibitors may be delayed and may be durable as opposed to single agent chemotherapy. Even in patients with an early response to atezo and nab-paclitaxel, I would continue the combination if possible, ...
Would you consider switching endocrine therapies for a peri-menopausal woman on adjuvant tamoxifen solely due to an estradiol level if this was checked and found to be significantly elevated?
I agree with Dr. @Dr. First Last that this is likely ovarian hyperstimulation from tamoxifen which can occur in 9-17% of women and is more likely to occur in younger women treated with tamoxifen therapy alone. In one study, a level of over 300pg/mL and follicular diameter over 30mm were used to defi...
What is your approach to the treatment of metastatic renal cell carcinoma with unclassified histology?
The key to managing unclassified renal cell carcinoma is to obtain a detailed histological and molecular characterization. Clarify with pathologist(s) regarding unclassified nature - are there some features characterizing the tumor as being of a recognizable subtype? Next generation sequencing to de...
How do you approach staging and treatment for a p16+ nasopharyngeal SCC?
First question is whether it is strictly p16 positive and confirmed EBER ISH negative. If so, I treat it like p16 positive oropharyngeal cancer with chemoradiation. I don't give adjuvant chemo. All the adjuvant chemo or induction chemo data is for EBER ISH positive nasopharyngeal carcinoma.
How would you treat high grade urothelial carcinoma of the prostate with only HGUC with CIS in bladder?
The optimal peri-operative systemic therapy for non-contiguous UC involving the prostate is unclear due to lack of high-quality prospective data. One key aspect of staging and evaluation would be to further evaluate the depth of involvement and exclude stromal involvement by the prostatic UC. Prior ...
What hematologic conditions are contraindications for a COVID vaccine?
The short answer is that a history of severe allergic reaction is really the only contraindication to COVID-19 vaccination. Perhaps, patients with systemic mastocytosis might be at increased risk of allergic reaction but I'm not aware of data to support that.The longer answer is a question of timing...
Would differentiating between embryonal vs alveolar rhabdomyosarcoma of the nasal cavity change your neoadjuvant chemotherapy regimen or make you consider neoadjuvant radiation in a locally advanced pleomorphic RMS?
The historic Embryonal vs. Alveolar differentiation is being replaced by a (PAX-FOXO) fusion positive vs. negative classification given the prognostic significance. In either case, the chemotherapy regimen is not likely to change in an adult patient. Pleomorphic RMS on the other hand, more common in...
Would concurrent endocrine therapy and PARPi maintenance be safe and appropriate after surgical treatment/adjuvant chemotherapy for a patient with BRCA1 mutated synchronous early stage HR+ breast CA and Stage IIA Fallopian tube carcinoma?
This does seem like a reasonable approach, based on my knowledge of eligibility criteria and tolerance in the OlympiA trial, which was a randomized trial of olaparib vs placebo in BRCA mutation carriers. In the OlympiA trial, patients with BRCA 1/2 mutation and hormone receptor positive breast cance...