Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Do you discontinue an aromatase inhibitor in a patient if they have a cardiac event while on the drug?
Randomized clinical trials and several meta-analyses that compared tamoxifen with aromatase inhibitors (Khosrow-Khavar et al., PMID 32065766 is a more recent one) demonstrated statistically significant increase in the rate of cardiovascular events in women taking aromatase inhibitors although the ab...
How would you approach the management of a patient with metastatic non‑small cell lung cancer who previously received whole brain radiation therapy three years ago and now presents with 20 new brain metastases on MRI?
How aggressive I would be depends on KPS (which sounds to be good in this case), the patient's extracranial disease status (which sounds to be controlled on current therapy in this case), plans from a systemic therapy perspective (will the patient continue on the same therapy and what was the patien...
Would you withhold immunotherapy for ES-SCLC during the COVID-19 pandemic?
Risks of COVID-19 infection and severe pneumonia seem to be higher in our patients with lung cancer. This is fairly early data and some of the patients included in those analyses were not receiving any active therapy. This suggests that at least some of the risk is simply frequent visits to the canc...
Are you using tarlatamab for neuroendocrine carcinomas (NECs) and poorly differentiated neuroendocrine tumors of GI (non-lung) origins?
We have treated a few patients with DLL3+ extrapulmonary NECs (epNECs) with tarlatamab, but we have not reported our experience yet. There have been responses, but mostly short-lived, but I know of cases where the responses were more durable than one would expect in epNECs progressing on first-line ...
How do you manage refractory myelofibrosis with thrombocytopenia, significant leukocytosis (>150), and ASXL1 mutation?
The answer to this question requires, first, that like any patient with a malignancy, this patient must be staged according to the clinical and laboratory data that define the clonal tumor burden of the disease in question, as well as its extent clinically. In the spirit of full transparency, my ans...
How do you manage refractory myelofibrosis with thrombocytopenia, significant leukocytosis (>150), and ASXL1 mutation?
The answer to this question requires, first, that like any patient with a malignancy, this patient must be staged according to the clinical and laboratory data that define the clonal tumor burden of the disease in question, as well as its extent clinically. In the spirit of full transparency, my ans...
In a patient with an EGFR exon 20 insertion mutation with stage IIIA lung adenocarcinoma, is there any experience using amivantamab + carboplatin + pemetrexed in a neoadjuvant fashion?
No. What is interesting is the use of not a chemoimmunotherapy neoadjuvant approach vs upfront surgery, since more likely than not, the EGFR exon 20 mutation offsets ICI efficacy.
Do you recommend adjuvant chemotherapy to a low risk T3N0 stage II colon cancer if there was bowel perforation upstream from the tumor, with mucosa underlying tumor itself being intact?
The upstream perforation is likely from another cause like inflammatory bowel disease, I am assuming. In this situation, I would offer chemo regardless of the upstream perforation. I would consider if they are eligible for a clinical trial that is incorporating ctDNA to help decide. But my understan...
How do you approach the treatment of HSCT-associated thrombotic microangiopathy?
TMA can be due to multiple insults: If the patient is on tacrolimus or cyclosporine, the dose should be reduced. These drugs cause the renal afferent arterioles to spasm, and RBC fragmentation can occur on that basis. It typically responds to a dose reduction If the patient was conditioning with TB...
How do you approach the treatment of HSCT-associated thrombotic microangiopathy?
TMA can be due to multiple insults: If the patient is on tacrolimus or cyclosporine, the dose should be reduced. These drugs cause the renal afferent arterioles to spasm, and RBC fragmentation can occur on that basis. It typically responds to a dose reduction If the patient was conditioning with TB...