Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Is there any benefit in continuing VRd instead of VR as maintenance therapy in transplant ineligible multiple myeloma?
I love this question - mostly because it makes me think of just one study, but really, I'm excited to hear what others have to say. I always think of RV-MM-PI-0752 (ASH 2018) studying the efficacy and feasibility of dose/schedule adjusted Rd-R vs continuous Rd in elderly and intermediate-fit newly d...
For persistent localized muscle-invasive bladder cancer following chemoradiation in patients who are not surgical candidates, what is an appropriate next therapy?
For this situation, optimal therapy is unclear. However, assuming the patient did not achieve clinical CR or recurred within a year, following maximal TURBT (which can achieve remissions in up to 15% of untreated patients), systemic therapy may be considered while tailoring therapy based on previous...
How do you counsel patients who are candidates for a clinical trial regarding their options?
I typically discuss the option with patients as early as possible in their diagnosis, and explain that at some point during their treatment they may become a candidate for a clinical trial. I discuss resources to look into clinical trials and what they mean for patients. We discuss patient website r...
When might you recommend adjuvant chemotherapy for fully staged/resected stage IA clear cell ovarian carcinoma?
Clear cell carcinoma of the ovary is one of the less common forms of ovarian cancer and is considered a high-grade tumor. It has a higher risk for recurrence and a poorer prognosis as compared to some other forms of ovarian cancer. For that reason, adjuvant therapy with platinum based chemotherapy i...
When would you ever choose cisplatin over carboplatin in extensive stage small cell lung cancer?
I prefer carboplatin over cisplatin in ES SCLC as there does not seem to be proven benefit and there is certainly higher risk for toxicity. There was a recent report at ASCO with similar findings. I reserve cisplatin for limited stage disease with concurrent radiation or as adjuvant therapy in cases...
What is the utility of immunotherapy in management of malignant peripheral nerve sheath tumors?
The correct answer would be "unknown" or "TBD". Enrollment on clinical trials, even broad phase 1 trials, would be encouraged in cases where SOC therapy has failed.
How do you approach unresectable or borderline resectable symptomatic nasal/paranasal Rosai-Dorfman disease?
Sinus/nasal/paranasal RDD can be difficult to treat in many cases, with numerous recurrences. There is no one size fits all strategy for these cases, and most recommendations are based on case reports/series or anecdotal experience. If surgical resection is not feasible easily and refractory/recurre...
For a patient on dialysis with metastatic clear cell renal cancer, what regimen would you use after front line immunotherapy?
For patients with ESRD on dialysis, prior data showed that pharmacokinetics of VEGF-TKIs in subjects with severe renal impairment were similar to those with normal renal function (Khosravan et al. 2010, Chen et al, 2016, Nguyen et al, 2016). Also, other retrospective studies showed safety of VEGF-TK...
How do you treat patients with newly diagnosed metastatic MiT Family Translocation Renal Cell Carcinoma?
The AREN1721 clinical trial is accepting patients of all ages with unresectable or metastatic TFE/translocation renal cell carcinoma (RCC). The tumors must have either TFE3 expression by immunohistochemical staining or evidence of a TFE3 or TFEB translocation. The three arm trial compares nivolumab,...
When would you offer adjuvant chemotherapy after axillary dissection and RT for an isolated squamous cell carcinoma of an axillary node with unknown primary?
This is a conundrum that is rare but real. Here are my recommendations: Make sure an extensive medical history is taken about potential lesions that were frozen, excised, etc. Speak with your pathologist to make sure the SCC is not originating from a pilar tumor, or similar adnexal skin appendage t...