Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How would you manage a patient with Stage IVB DLBCL with refractory disease in the retroperitoneum and spleen after 6 cycles of RCHOP?
The management of primary refractory stage IV DLBCL is complex and generally not successful. See NCCN Guidelines for details. I would distinguish, however, between those patients who are clinically refractory and those who have clinically responded well but may have residual disease by imaging, i.e....
How would you treat lung adenocarcinoma patients progressing on osimertinib who are not candidates for chemotherapy?
First, I will point out that there are a number of other questions that have come up that touch on this question which I have referenced below. This is certainly a challenging scenario. Obviously, if a patient is not a candidate for chemotherapy, they are likely not a candidate for a clinical trial,...
How late after surgery would you consider prescribing osimertinib as adjuvant therapy in patients with resected EGFRm NSCLC?
Most patients will received adjuvant chemotherapy for 3-4 cycles. Adjuvant chemo typically begins 4-12 weeks after surgery. Therefore, the initiation of adjuvant sequential Osimertinib would typically occur 3 weeks after the last cycle of chemotherapy.
How do you incorporate denosumab into the surgical management of giant cell tumor of bone?
Denosumab forever. Giant cell tumors of bone have a clonal cancer component and then osteoclasts that are hypnotized by the cancer. Denosumab works on the osteoclasts so they quit listening to the cancer and then the whole thing turns to bone. Denosumab does not kill anything and the cancer cells ar...
In a patient with metastatic prostate cancer on abiraterone planning to start Radium-223, what is the minimum interval between the last dose of abiraterone and the first dose of Radium?
In-vivo studies have shown abiraterone is rapidly absorbed after oral intake and bioavailability is <10% in fasting state. Abiraterone has a half-life of 12-24 hours and if the dose is not repeated, most of the administered drug should be eliminated within a few days. Based on this, I do not see any...
When should a gallium-dotatate scan be incorporated into the initial evaluation of a patient with a carcinoid tumor of the appendix?
Good question! I would first refer the reader to my two favorite papers on appendiceal NETs (Rault-Petit et al., PMID 29557879; Landry et al., PMID 18645109) to understand and help determine: 1) which patients are at highest risk of lymph node metastasis and thus require a right hemicolectomy, and 2...
How would you counsel a patient regarding possibility of ovarian preservation at time of surgery for malignant mesothelioma initially discovered in a myomectomy specimen and involving peritoneal surfaces?
If the mesothelioma is on the lower grade of the spectrum and the margins negative, I would offer fertility preservation if feasible at surgery. If high grade, I would have a discussion about prognosis with the patient. If all the tumor can be resected with an R0 resection, it should be offered - th...
How would you treat an adolescent or young adult with newly diagnosed hepatosplenic T-cell lymphoma?
HSTCL accounts for <1% of lymphomas. It typically presents in young males, 10-20% of whom are on chronic immunosuppression such as TNF alpha inhibitors. The prognosis for hepatosplenic t-cell lymphoma is grim. Patients can achieve a CR, but relapse quickly with a short median OS. When possible, pati...
How would you treat laryngeal neuroendocrine carcinoma?
It would depend on extent and differentiation. If small cell, chemo RT. No point in surgery because they almost always develop distant metastasizes. If differentiated, it would depend on extent and surgical alternative.
How do you approach a patient with multiply relapsed germ cell tumor with rising tumor markers but no obvious site of disease?
From the description, it presumes that this is a patient who previously received BEP, high dose chemo with transplant, and "radiotherapy". Not sure whether that represents CNS mets that were radiated. The most important aspect is to be certain marker rise due to progressive cancer. hCG mildly elevat...