Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
When would you recommend adjuvant therapy for a patient with urethral adenocarcinoma after partial urethrectomy?
My first approach in this setting is to have the pathology reviewed by an expert tumor pathologist, and to be sure of the T stage, margins, N/M stage, and whether any tumor markers are heavily expressed. If there is a strongly expressed tumor marker, such as CEA, I will obtain baseline, and interval...
How do you approach adjuvant therapy for a premenopausal patient with a pathologic BRCA1 mutation whose TNBC had a complete response to neoadjuvant chemotherapy except for an ITC in one LN?
This is technically a Stage 0/RCB-I after neoadjuvant chemo when I calculated it. This patient would not qualify for the current clinical trials looking at additional therapy (ECOG capecitabine vs platinum, now closed; the SWOG pembrolizumab vs observation, still accruing). Looking at CREATE-X, the ...
Should targeted therapies such as Brentuximab or Crizotinib be used in the upfront management of anaplastic large cell lymphoma in a pediatric or AYA patient?
Good question. Importantly, I am assuming that the question is for ALK+ patients who have systemic disease because ALK inhibitors have no role in ALK- disease and cutaneous only ALCL is really an entirely different entity.In fact, the question is the primary aim of COG trial ANHL12P1 which uses eith...
How do you approach contraception and pregnancy counseling in women of childbearing age with Desmoid tumors who may be contemplating future pregnancy?
Sporadic desmoid tumors have a propensity (80% of cases) for women of childbearing age and they do seem to come up during and after pregnancy. Here are my thoughts on contraception and pregnancy for women with desmoid tumors.1. Norethindrone pill. This is not specific to people with desmoids. I am a...
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...