Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
What surveillance imaging do you obtain for stage III melanoma patients after completing systemic adjuvant therapy?
I agree with Dr. @Dr. First Last. The guidelines for surveillance allow some personalization based on patient specific characteristics. For stage III melanoma patients on adjuvant therapy (or not), we scan with CT scans every 3 months for 2 years, every 6 months up to 5 years. If there is something ...
How would you treat a patient with widely metastatic penile squamous cell carcinoma with mixed response to 4 cycles of TIP chemotherapy?
Penile squamous cell carcinoma (PSCC) is a challenging and rare malignancy. In those with metastatic disease following therapy with cisplatin-based combination chemotherapy, there are no optimal or approved options. Clinical outcomes are dismal with currently used salvage therapy agents. Cetuximab o...
What first line regimen for metastatic esophageal or GEJ adenocarcinoma would you use in an elderly patient (>80) with medical comorbidities?
I believe that there is no one right answer to this question. Elderly patients with chronic health problems require a full assessment before considering a particular treatment regimen. By "full", I mean learning as much about them as possible, including not just their performance status, renal funct...
Do you routinely check platelet counts after COVID-19 vaccines in patients with chronic ITP?
Yes. the side effects of COVID vaccines are still evolving. Mild to moderate thrombocytopenia was noted and severe thrombocytopenia is extremely rare. I would follow an abundance of caution and do weekly complete blood counts, especially in the ITP patient.
What is your approach following R1 resection in a patient who has received total neoadjuvant therapy for rectal cancer?
This is a challenging scenario and there is not a one-size fits all solution. My decision making would involve thorough assessment of the patient's performance status, co-morbidities, pre-treatment extent of disease, tolerance of therapy, and review of what TNT regimen was employed: number of chemo ...
Would you recommend use of ESA for anemia of kidney disease in the setting of metastatic solid tumor malignancy?
It is not unreasonable in CKD patients with symptomatic anemia and a non-curable metastatic cancer to consider using an ESA. However, this requires an extensive discussion with the patient. ASCO/ASH guidelines recommend against the use of these agents in patients with curable malignancies, so if the...
Is there a role for frontline combination therapy with a hypomethylating agent plus venetoclax for high risk MDS?
Yes, if we extrapolate from AML and based on promising phase 1b clinical trial results (link below) so far, but venetoclax is not approved for MDS as of yet. Improved CR but also increased cytopenias, dose has not been confirmed yet. https://www.ashclinicalnews.org/on-location/ash-annual-meeting/ven...
What is your approach to a patient with an EGFR exon 19 mutated NSCLC who develops progression on osimertinib and repeat biopsy demonstrates the EGFR exon 19 mutation and a new BRAF V600E mutation?
I have a couple of these patients - and the triplet combo seems to be helping them. There is really no good data to support this combination. However, the AE profile of these agents are different and combination should not increase toxicity theoretically. BRAF, MET, and EGFR are all on chromosome 7 ...
Would you offer adjuvant immunotherapy for a melanoma patient with lymphocytic colitis?
If the patient has active/symptomatic lymphocytic colitis and/or is undergoing therapy for lymphocytic colitis, I would not offer adjuvant checkpoint inhibitor immunotherapy as the risk/benefit ratio is likely to be too high. As the underlying pathogenesis of lymphocytic colitis is not entirely clea...
Do you routinely offer a bisphosphonate or denosumab to multiple myeloma patients without skeletal lesions?
Our practice is to give 2 years of bone-directed therapy in all comers. Preferably bisphosphonates over denosumab for cost reasons unless needed due to CKD or intolerance.I agree that the case is less compelling for patients without skeletal lesions at baseline. An old RCT of bisphosphonates versus ...