Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How do you treat diffuse large B cell lymphoma (DLBCL) in a patient with cirrhosis complicated by thrombocytopenia?
Thank you for the question. This is a very challenging case. There are different factors to consider, such as age, PS, stage, and actual liver function. Liver function may have been affected by lymphoma.Most likely, the patient will require dose reductions of standard R-CHOP (such as mini R-CHOP). A...
How do you treat diffuse large B cell lymphoma (DLBCL) in a patient with cirrhosis complicated by thrombocytopenia?
Thank you for the question. This is a very challenging case. There are different factors to consider, such as age, PS, stage, and actual liver function. Liver function may have been affected by lymphoma.Most likely, the patient will require dose reductions of standard R-CHOP (such as mini R-CHOP). A...
What vitamins and minerals do you check yearly for patients post gastric bypass surgery?
Following Roux-en-Y gastric bypass it is essential to monitor micronutrients, vitamins, and minerals because malabsorption and long-term complications may occur with improper care. Based on ASMBS 2016 Nutrition Guidelines, AACE/TOS/ASMBS 2019 updates, and Endocrine Society recommendations, here are ...
For a BRCA1+ patient with a history of stage IVB endometrioid ovarian carcinoma s/p upfront surgery and adjuvant chemotherapy who has now completed 3 years of maintenance niraparib and is NED, how would you counsel about discontinuing vs continuing PARPi therapy?
Recommendation: I recommend that this patient with Stage IVB ovarian cancer, with a complete response to surgery, chemotherapy, and 3 years of maintenance PARPi, be counseled to discontinue niraparib.Background:The duration of therapy for primary maintenance PARPi should be tailored based on the ass...
What features would push you towards re-operation for completion staging vs observation for a premenopausal woman with stage II borderline tumor of the ovary with capsule rupture and no other evidence of gross residual disease?
I would only reoperate if there were a survival benefit, symptomatic benefit, or change in treatment regimen. From the description, it doesn't seem like this meets any of those criteria.
In what situation would you recommend ipilimumab + nivolumab over relatlimab + nivolumab in the treatment of metastatic melanoma?
There is no clinical trial to provide a direct comparison between the two regimens, hence the answer to this question is usually driven by personal interpretation of the data and patient preference. The data for both regimens show a statistically significant PFS benefit and a superior response rate ...
Does a very high Oncotype score influence your approach to adjuvant treatment in a patient with ER positive breast cancer?
This is a very intriguing question that has a simple answer. There is no data on choice or aggressiveness of chemotherapy and resulting benefit in patients with higher oncotype recurrence score. What regimen to use remains a judgement call, but for most patients with ER+/node negative tumors with a ...
How do you counsel patients about the likelihood of improvement in kidney disease after anti-cancer treatment is initiated in a patient with malignancy associated membranous nephropathy?
There are numerous case reports to support that if the patient has a paraneoplastic MN then the expectation is that the renal lesion will respond to cancer directed therapy.
What is the appropriate concurrent chemoradiation regimen to treat unresectable stage IIB lung adenocarcinoma?
Historically, many locally advanced NSCLC trials have included patients with unresectable stage II disease. While those patients comprised only a few % of the study population, I think it is largely reasonable to extrapolate findings from stage III NSCLC patients to patients with unresectable stage ...
For stage III NSCLC treated with definitive intent chemoRT, how do you decide to proceed with surgery vs consolidation immunotherapy?
When we initially evaluate a patient with locally advanced NSCLC, we make the decision upfront about whether the patient will be managed surgically or not, and then we stick to that plan as long as everything proceeds as expected. So someone treated with definitive intent would get durvalumab (shown...