Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Would you ever offer adjuvant immunotherapy after definitive chemoradiation for esophageal cancer?
A great question – one that we really don’t have data to answer quite yet. Obviously, we do have guidance for resectable patients. CheckMate 577 was a randomized, double-blind, placebo-controlled phase 3 trial in patients with stage II or III esophageal or gastroesophageal cancer who received neoadj...
At what lower end of recurrence risk do you offer adjuvant imatinib for patients with resected GIST?
The "lower end of recurrence risk" justifying adjuvant Imatinib is indeed a personalized decision between the provider and the patient based on risk-tolerance on both sides. In the absence of "cost-effectiveness" data, this has to be a mutual decision that works for both sides. In general, <20% risk...
Do you check pertussis serologies when sending labs for antiphospholipid syndrome?
The short answer is no. I do not check pertussis antibodies when evaluating patients for anti-phospholipid syndrome. A slightly longer answer is still no and, for example, a review published in the Annals of Rheumatic Diseases by Ron Asherson in 2003 discussing the relationship between various infec...
When can defibrotide be discontinued before the 21-day treatment course is completed in a pediatric patient with SOS?
There is no data to support the 21-day use in everyone. Also, some patients might even need a longer course than the prescribed 21 days if manifestations are ongoing. A good general rule of thumb would be to continue (provided no bleeding or other toxicities) for 3-5-7 days post resolution of ong...
For a patient with metastatic NSCLC who had progression x2 at a single site treated w RT, would you switch systemic treatment?
Continue immunotherapy.
What treatment would you offer a patient who underwent surgery for an extrahepatic cholangiocarcinoma and subsequently developed an isolated malignant biliary stricture?
In this case, for an isolated bile duct recurrence, local radiation therapy can be considered. It would be preferred over systemic therapy as radiation therapy can provide long term disease control. The case would have to be discussed with the radiation oncologist regarding feasibility and type and ...
Do you offer maintenance rituximab in transplant ineligible patients with mantle cell lymphoma?
The data on the role of rituximab maintenance therapy in transplant ineligible patients with mantle cell lymphoma are not straightforward to interpret. The most often cited experience (Kluin-Nelemans, et al., PMID 22873532) is a complicated study with two randomizations: induction therapy was either...
Would you use upfront immunotherapy in a patient with MSI high metastatic colon cancer in the setting of high volume disease?
These are challenging. I have used triplet in a couple of these who needed quick cytoreduction and for purposes on neoadjuvant for possible liver resection given the 30 percent primary refractory.
What adjuvant systemic therapy would you offer to a healthy elderly woman with a 5mm, node negative, grade 2 HR+HER2+ invasive lobular carcinoma?
Although several studies have clearly indicated a higher risk of recurrence for early stage HER2+ breast cancers, the absolute risk for T1aN0 breast cancers is still quite low. The studies have been limited by small numbers, but there are retrospective series suggesting excellent outcomes without ad...
How do you use daratumumab in the treatment of systemic AL amyloidosis?
I now routinely incorporate daratumumab into the frontline treatment for AL amyloidosis as well as in the relapsed/refractory setting. The data supporting frontline use comes from the phase III ANDROMEDA study which randomized patients to Dara-CyBorD to CyBorD (cyclophosphamide, bortezomib, dexameth...