Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
When using IO therapy for front line treatment of metastatic RCC, is there a role for cytoreductive nephrectomy?
The role and timing of debulking nephrectomy in mRCC has been evolving over the last several years. This is in part due to CARMENA, which in my opinion reinforced that patient selection is critical, and in part due to increased activity of systemic therapy. I think patients with limited IMDC risk fa...
With new data showing similar outcomes of mismatched unrelated donor and haploidentical related donor allogeneic transplants using post transplant cyclophosphamide, how does one decide which donor is optimal?
It is certainly an unresolved question, and the short answer is that either would be an acceptable option with post-transplant cyclophosphamide (and I have used both). All recipients of mismatched donor transplants should be tested for the presence of donor specific antibodies, and their presence co...
What is your preferred second line therapy for patients with metastatic large cell neuroendocrine carcinoma of the lung after progression on first line chemo-immunotherapy?
Let's start by backtracking to the original treatment recommendation. Since large cell neuroendocrine carcinomas (LCNEC) of the lung can harbor mutations in EGFR or BRAF or even ALK rearrangements, next generation sequencing is appropriate for patients with advanced disease.Assuming no targetable al...
What is your preferred bone modifying agent and frequency of dosing in patients with breast cancer and bony metastases?
ASCO guidelines recommend zoledronic acid 4 mg every four weeks or every 12 weeks, or denosumab 120 mg subcutaneously every four weeks, or intravenous pamidronate 90 mg every four weeks. Present guidelines do not endorse one bone modifying agent over another, however, zoledronic acid and denosumab a...
Is there evidence that oral contraceptive pills are less effective in pre-menopausal women on tamoxifen chemoprevention?
While I am not aware of such study, going back to the history of how the tamoxifen, compound ICI 46,474 was developed as an oral contraceptive, as well as numerous evidence of estrogen-mimicking properties we observed in the laboratory, one can safely assume that tamoxifen will certainly interfere w...
How is pediatric and young adult primary bone lymphoma risk stratified?
I can only talk to the pediatric experience. Studies done a number of years ago showed that multiple bone lymphoma does not give a poorer prognosis and therefore in Pediatric NHL, even widespread bone is not stage IV or FAB LMB Group C. If B-lineage, it would be stage III or Group B hence 4 courses ...
When giving single agent docetaxel for patients with metastatic NSCLC who have progressed on platinum and immunotherapy, do you stop after 6 cycles or do you continue as long as tolerated and disease is stable?
When giving docetaxel to patients with NSCLC who have disease progression after platinum chemotherapy and immunotherapy, I typically give it in combination with ramucirumab per the REVEL study (Garon et al., PMID 24933332). In this study, patients with NSCLC who had disease progression after platinu...
How do you approach evaluation of pulmonary vein thrombosis?
Pulmonary vein thrombosis is a rare condition that is usually associated with injury to the vessel, for example after surgery or lung transplantation, or as a complication of lung cancer. I am not aware of any data on the relative efficacy of different anticoagulants in PVT but from a biologic persp...
Would you consider bone marrow transplant in a pediatric patient with recurrent HLH with no identified exogenous trigger or HLH-associated mutation?
What is your approach for adjuvant endocrine therapy in a female with HR+ breast cancer with history of provoked DVT while on OCPs?
In a postmenopausal female with HR+HER2- breast cancer and a history of DVT on OCPs, I would recommend adjuvant endocrine therapy with an aromatase inhibitor and not tamoxifen. This is based on improved efficacy for aromatase inhibitors compared to tamoxifen in this population, and VTE risk associat...