Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
What second line therapy would you use for metastatic clear cell RCC after a 6-12 month response to ipilimumab/nivolumab followed by development of multiple bone metastases but stable soft tissue disease?
Great question. Options include agents such as cabozantinib, lenvatinib/everolimus, and axiitnib. I favor cabozantinib in this setting because of its track record of activity in bony metastases in the METEOR trial and other studies. Also, please keep in mind the availability of CONTACT-3, which is a...
How would you handle recurring toxicity such as cytopenias for patients receiving subcutaneous pertuzumab/trastuzumab?
SQ HP doesn't cause cytopenias, and it would still be safe to administer SQ HP in the setting of cytopenias, so it hasn't had an impact on my utilization.
How would you manage a patient with type 1 cryoglobulinemia secondary to MGUS?
Rituxan can be tried if IgM type MGUS. Please find the attached ASH article on How I treat cryoglobulinemia by Muchtar, Magen, and Gertz; PMID 27799164.
Would you consider treating a patient who has an unresectable slowly growing PET avid lung mass with concurrent chemo RT when multiple biopsy attempts have only resulted in pathology "suspicious" for adenocarcinoma of the lung?
I would consider treating the patient if they have a highly suspicious biopsy with the proper clinical context and after speaking with the pathologist to understand why the report indicates only "suspicion" rather than "confirmation". The patient in question had "multiple biopsy attempts" and demons...
How soon after a VTE would you feel comfortable with a patient undergoing an elective surgery?
Here is my approach: Many factors play a role in decision making such as type of venous thromboembolic event, clot burden, provoked versus unprovoked nature of the event, patient's bleeding and clotting phenotype, associated risk factor such as cancer, etc, type of anticipated surgery, and risk for ...
What is your strategy for having COVID positive patients resume infusions after they have recovered from the infection?
If they are asymptomatic and doing well, we may resume systemic therapy as clinically indicated. I have used either chemotherapy or IO, depending on the case. We follow institutional guidelines but retesting for Covid19 is not required at our center if the patient has recovered and has been asymptom...
In locally advanced EGFR-mutated NSCLC with initial good response to osimertinib, how do you manage local progression of the primary?
In this context, local progression at one site after a good response to osimertinib makes good clinical sense. Given that the next line of therapy is chemotherapy, being able to continue the TKI as long as possible while addressing oligoprogression with RT for local control is appealing. However, we...
Do you still consider isolated skin involvement by primary breast cancer without inflammatory change to be locally advanced stage III disease?
We almost always review these cases at our multidisciplinary case conference and there is debate. These are the lessons I've learned from our team: (1) if the primary tumor is very superficial and directly invades the skin, then it is not stage III and is staged based on tumor size, (2) if there is ...
Would you add chemotherapy to a TKI in treating an elderly patient with de novo CML blast crisis?
Treating CML blast crisis is challenging in any patient and there is no standard of care. Generally, it is recommended to treat with both chemotherapy and a TKI. However, it is most important to adjust treatment to the patient. If a patient is frail and unable to tolerate chemotherapy, I don't think...
Is it safe to treat a recurrent esophageal SCC with definitive chemoradiation after a prior endoscopic mucosal resection?
I would not be concerned about perforation or fistula formation. With an EMR, the resection takes off the mucosa/submucosa and leaves the wall intact. There should be sufficient time from the prior procedure to have full mucosal regrowth and the wall integrity should be well maintained.