Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Would you consider treatment of advanced HCC with checkpoint blockade after progression on sorafenib?
Yes, I would consider checkpoint blockade, particularly a research protocol. HIV status may complicate trial enrollment but would not necessarily be an issue off study. Hepatitis status as a predictive factor for response is interesting and is being currently investigated. In my practice, we conside...
How do you treat GIST with de-differentiation to pleomorphic sarcoma on chronic therapy with imatinib?
Once a GIST, always a GIST. Sarcomas that are driven by a translocation can behave badly but they never ever get rid of their translocation. Possibly by saying the GIST has de-differentiated your pathologist is telling you the GIST looks more aggressive. Or maybe it was never was GIST in the first p...
Should we be using comprehensive panels when testing for hereditary cancer syndromes?
I think the days of single gene testing are limited. Certainly if a deleterious gene has already been identified, family members only need to be tested for that mutation. In rare circumstances when there is a large family with a substantial cancer history that perfectly replicates a known syndrome, ...
Do you counsel patients on the (very small) risk of permanent hair loss with docetaxel?
I have to admit that I didn't recognize permanent hair loss with docetaxel until the legal commercials - the same ones your patients are seeing that are prompting their questions. After careful reflection and discussion with my nursing staff, we can identify 2 patients over 17 years who have not had...
Can we ever observe newly diagnosed chronic phase CML patients and not immediately start them on therapy?
I can't think of a situation that would justify a "watch and wait" approach to CML. There are a number of effective therapies. Even if a patient has side effects from one TKI, there are others to choose from. What justification is there for not using an effective therapy? What is the rationale? Da...
Has the combination of daratumumab, bortezomib, and dexamethasone been tried for the treatment of plasma cell leukemia?
Do you ever discontinue ibrutinib in patients with CLL who have a good response?
For patients who are responding well to ibrutinib and tolerating the drug well, I do not discontinue ibrutinib. The clinical trials of single agent BTK inhibitors have all continued therapy indefinitely, which is a logical approach considering that very few will attain minimal residual disease negat...
How would you treat a T1b N0 metaplastic myoepithelial breast cancer regarding role of adjuvant therapy?
Assume triple neg. Depends on patient's age and performance status and lots of discussions. I would definitely not treat a T1a and would have to have strong reasons to treat a T1b
Do you offer bladder-sparing approaches as an alternative to cystectomy for surgery-eligible patients with muscle-invasive bladder cancer?
We have a bladder cancer multispecialty clinic at SCCA/UWMC in which we also see patients with localized MIBC and we balance carefully risks vs benefits, rationale, data, details & logistics of options. Overall, cisplatin-based chemotherapy (for fit patients) ->radical cystectomy with PLND, OR maxim...
Which chemotherapy regimen (if any) do you recommend for palliative concurrent chemoradiation for a symptomatic patient with metastatic cervical carcinoma and CKD stage 4 (GFR 15-29)?
For patients who cant get cisplatin because of poor kidney function, we have used taxol at 45-50 mg/m2 weekly ( metabolized through liver) based on phase 2 data. In our experience it is tolerated well.