Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Would you consider lymphovascular invasion at the margin to be a positive margin in breast cancer surgery?
LVI is an independent risk factor for local relapse despite adequate treatment. That being said, we don’t chase LVI to get negative margin as it is non contiguous involvement and not contiguous process which warrants any reexcision.
Do you recommend long term anticoagulation for all patients with first time unprovoked VTE?
I consider long term anticoagulation after a first unprovoked proximal DVT or PE in patients with low bleeding risk, especially if they are male. Risk/benefit discussion is employed for patients who have a higher bleeding risk after a first unprovoked VTE event.
How do you proceed with treatment of a patient with stage IIIB NSCLC who progresses DURING treatment with concurrent weekly carboplatin/paclitaxel and radiation?
I have been looking at this question for a little over a week, and struggling to know how to answer this. The relevant trials for a patient with PDL1 somewhere between 0 and 49% (KEYNOTE-189, KEYNOTE-407, KEYNOTE-042, CheckMate 227, and 9LA) would have excluded patients who received either adjuvant ...
When do you utilize lenalidomide in patients with MDS without del(5q)?
Lenalidomide is beneficial in low-risk and int -1 risk MDS patients with anemia even without del 5q in combination with EPO as shown in ECOG 2905 study.List et al., PMID 33439748These low-risk MDS tend to be MDS with refractory anemia and ringed sideroblasts.MDS RS with thrombocytosis tends to be re...
What type of surveillance would you recommend following resection of primary mucinous carcinoma of the skin?
A full skin examination every 6 to 12 months. Reminding the patient to call the clinic immediately for any symptoms that are unusual, or for a new skin lesion and perform a symptoms directed work-up.
How would you approach a patient presenting with pancytopenia and splenomegaly whose bone marrow biopsy is morphologically normal but has a positive Philadelphia chromosome in bone marrow as well as peripheral blood?
Given pancytopenia and splenomegaly, I’m surprised bone marrow is read as normal. Look for evidence of myelofibrosis in marrow by performing reticulin stain. How big is the spleen? This picture is consistent with CML. What is the blasts % in blood and marrow? What is the basophil %? I would treat as...
Would you use a PARP inhibitor in metastatic ER/PR positive breast cancer with somatic BRCA1 mutation but negative for germline mutation?
I certainly would. This is based on data from TBCRC 048 that showed efficacy in sBRCA1/2 as well as gPALB2. Tung et al., PMID 33119476
Do you approach the diagnosis and treatment of HIT patients differently in the outpatient setting or in a resource-limited community setting?
The concern for heparin induced thrombocytopenia is a complex problem. If the patient has HIT by 4T score and thrombosis, then admission to the hospital for initial management including direct thrombin inhibitor is the correct path awaiting confirmation by ELISA and platelet release assay. If negati...
How would you treat an elderly patient with CD30 negative PTCL NOS involving base of tongue, vallecula and bilateral cervical lymph nodes?
This appears to be a stage II PTCL, NOS. Involvement of the tonsils, base of the tongue, and surrounding lymphoid tissue is considered nodal disease. If there is true involvement of the airway then it may be called "extranodal", but the treatment remains unchanged.Randomized studies are lacking/limi...
How do you approach adjuvant endocrine therapy in a pre-menopausal patient with node negative HR+HER2- breast cancer with a high Oncotype RS who received adjuvant chemotherapy?
The SOFT/TEXT study can be used to answer this question. SOFT was a phase III study in premenopausal women with ER+ disease comparing ovarian function suppression (OFS)+ an aromatase inhibitor (AI) to OFS + tamoxifen vs tamoxifen alone; TEXT compared OFS+AI vs OFS+tamoxifen. The vast majority of wom...