Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How would you manage a patient with early stage ER+ HER2+ breast CA who cannot receive definitive local therapy due to severe cardiopulmonary co-morbidities?
My management would depend on the nature of the severe cardiopulmonary co-morbidity and the clinical stage of the disease. For someone who is not a candidate for surgery (even with local axillary block, etc.), but does not have a cardiomyopathy, and is otherwise fit for systemic therapy (ECOG PS 0-2...
Would you ever consider prophylactic anticoagulation in patients with CKD requiring ESA therapy?
I would not start anticoagulation in this setting solely because the patient is to receive ESA treatment, but would advocate for adjusting the ESA dose to maintain a hemoglobin of 9-10 g/dL, since a number of studies suggest that targeting higher hemoglobin levels is associated with increased risk o...
Would you consider using a PARP inhibitor in a patient with metastatic pancreatic cancer with a germline ATM mutation after progression on FOLFIRINOX and gemcitabine based chemotherapy?
I would not use a PARP inhibitor in this situation. The available evidence on PARP inhibitors in pancreatic cancer is in the first-line maintenance setting, among patients with germline BRCA mutations (and now also among patients with somatic BRCA mutations and with germline PALB2 mutations). So cur...
Do you alter your surveillance plan after achieving local control for patients with breast CA with locoregional recurrence given the higher risk of distant recurrence?
The data regarding best surveillance strategies for patients with locoregional recurrence is limited. Patients who recur with extensive locoregional involvement but are salvaged with systemic and local therapies are at very high risk of relapse. Therefore, for such patients, I am leaning towards sur...
How do you approach therapy for a fit adult with relapsed AML with CNS involvement after allogeneic stem cell transplantation?
Agree with Dr. @Dr. First Last. If on immunosuppression, would stop immunosuppression. HIDAC q12 hours x 5-6 days reinduction is a regimen that can be used for relapsed AML. There is some data in adding venetoclax to chemo induction and should be considered.If starting venetoclax single agent to add...
What gemtuzumab regimen and schedule (with standard 7 plus 3) would you use for a newly diagnosed AML patient with favorable genetics?
Per the ALFA-0701 trial, we administer GO (3 mg/m2, capped at 4.5 mg vial) on days 1,4, and 7 of induction therapy with 7+3.
Under what circumstances would you consider outpatient induction for AML?
At some centers, I know that induction with venetoclax and azacytidine/decitabine/low dose cytarabine or liposomal cytarabine/daunorubicin (CPX-351) for patients with newly diagnosed AML has been administered in the outpatient setting. However, in these centers (such as Moffitt Cancer Center), there...
How do you choose your systemic treatment for primary mediastinal grey zone lymphomas?
Most of the literature (although not prospective) supports treating with an R-CHOP/EPOCH vs. traditional ABVD. As such, I tend to treat with R-DA-EPOCH. When I have had the unfortunate case of a relapsed/refractory patient, I have tended to treat with some of the newer HL salvage regimens.
Is it essential to wait one week after loading dose of erbitux to start RT for head and neck cancer?
I would start RT if it means you're going to risk delaying RT start window. Another question is, why are you giving Erbitux for post-op treatment? Can you use another agent?
How do you counsel patients on JAK inhibitors about the risk of venous thromboembolism, MACE, and cancer?
I advise patients that there remain many unanswered questions regarding these side effects that will be resolved with longer term use with these agents. Shared decision-making is critical for these discussions. Data available from current extensions of clinical trials for JAKi, additional risk facto...