Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How would you manage a patient with history of stage IIIC HGSOC after secondary cytoreduction of isolated inguinal node recurrence 12 years after primary treatment?
Difficult case. Could just observe if the lymph node is an isolated recurrence with no extracapsular extension. If extracapsular extension, could offer standard chemotherapy again, or just single agent carboplatin to minimize side effects x 6 cycles. This patient should have been extra-sensitive to ...
Would you recommend aspirin 600 mg daily for two years to a patient with Lynch syndrome and a history of colon cancer based on the results of the CAPP2 study for cancer prevention?
Yes, I would recommend this, with some caveats/considerations. 600 mg of aspirin daily x 2 years was the dose/duration shown to be effective in CAPP2--recently updated outcomes data from this trial (Lancet 2020) demonstrated an IRR of 0·50 (0·31–0·82; p=0·0057) for CRC among participants who were ab...
What would be the ideal patient to receive selinexor-based therapy over other options for penta-refractory multiple myeloma?
Selinexor makes sense in combination with a partner, usually, either Carfilzomib or Pomalidomide, after patients are refractory to RVd --> Dara-Pd --> KPd --> Belantamab. An alternate route might be Dara-Rd --> KPd or PVd --> Bela. In essence, Selinexor is what I use when there's nothing left standa...
In a patient with breakthrough VTE on rivaroxaban, would you switch to apixaban or an agent with a different mechanism of action?
A complex situation and a lot will depend on the clinical circumstances e.g., compliance, type of failure, etc. I would still consider apixaban. However, if the failure was a more serious event, consider alternative anticoagulants.
Are you selecting any specific patient cohort with metastatic NSCLC for treatment with the CheckMate 9LA protocol of ipilimumab + nivolumab + 2 cycles of chemotherapy?
I am not currently using this regimen although, it is certainly an acceptable regimen.
What is the preferred treatment approach for an AYA patient with intermediate to high risk Hodgkin lymphoma: The pediatric approach (ABVE-PC +/- radiation) or the adult approach (ABVD with possible escalation to BEACOPP)?
The question of which regimen is preferred needs to be individualized for a given AYA patient. The recent development of pediatric specific NCCN guidelines with some overlap with adult guidelines for Hodgkin Lymphoma can provide a guide. The acute toxicity tradeoffs of myelosuppression with ABVE-PC ...
How would you manage an incidental catheter-related thrombosis in a functioning dialysis catheter?
If the patient is asymptomatic and the catheter is functioning well, I recommend starting anticoagulation.If the patient develops symptoms, he or she should still be anticoagulated but the catheter removed. Anticoagulation options in ESRD patients include Coumadin, Eliquis (my preference is a dose o...
Would you consider use of upfront BV plus nivolumab to treat Hodgkin Lymphoma in elderly patients unable to receive standard chemotherapy?
I would definitely consider BV/Nivo in frontline settings for elderly patients if no trial is available.Prognosis is worse in elderly HL for several reasons - SOC chemotherapy is not well tolerated and biology of the disease is different (mixed cellularity being prevalent and more frequent EBV posit...
After completing 6 cycles of docetaxel plus ADT for metastatic hormone-sensitive prostate cancer per CHAARTED, are there clinical scenarios in which you would add an additional AR targeted agent (ex: enzalutamide, abiraterone, or apalutamide) to ADT?
This is an important question and has in part been asked as part of subgroup analyses of the phase 3 ENZAMET, ARCHES, and TITAN mHSPC trials. In these trials, there was clinical benefit observed with combined chemohormonal therapy AND potent AR inhibition, sequentially in ARCHES/TITAN, and in combin...
How would you approach treatment of a bulky stage II DLBCL in a patient >80 with a contraindication to anthracyclines but otherwise good performance status?
The management of DLBCL in the elderly, particularly those unfit for standard anthracycline-based chemoimmunotherapy, is an area of unmet need and clinical challenges. While there is no single standard of care, and participation in clinical trials designed for this patient population is encouraged, ...