Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
When do you utilize lenalidomide in patients with MDS without del(5q)?
Lenalidomide is beneficial in low-risk and int -1 risk MDS patients with anemia even without del 5q in combination with EPO as shown in ECOG 2905 study.List et al., PMID 33439748These low-risk MDS tend to be MDS with refractory anemia and ringed sideroblasts.MDS RS with thrombocytosis tends to be re...
What type of surveillance would you recommend following resection of primary mucinous carcinoma of the skin?
A full skin examination every 6 to 12 months. Reminding the patient to call the clinic immediately for any symptoms that are unusual, or for a new skin lesion and perform a symptoms directed work-up.
How would you approach a patient presenting with pancytopenia and splenomegaly whose bone marrow biopsy is morphologically normal but has a positive Philadelphia chromosome in bone marrow as well as peripheral blood?
Given pancytopenia and splenomegaly, I’m surprised bone marrow is read as normal. Look for evidence of myelofibrosis in marrow by performing reticulin stain. How big is the spleen? This picture is consistent with CML. What is the blasts % in blood and marrow? What is the basophil %? I would treat as...
Would you use a PARP inhibitor in metastatic ER/PR positive breast cancer with somatic BRCA1 mutation but negative for germline mutation?
I certainly would. This is based on data from TBCRC 048 that showed efficacy in sBRCA1/2 as well as gPALB2. Tung et al., PMID 33119476
Do you approach the diagnosis and treatment of HIT patients differently in the outpatient setting or in a resource-limited community setting?
The concern for heparin induced thrombocytopenia is a complex problem. If the patient has HIT by 4T score and thrombosis, then admission to the hospital for initial management including direct thrombin inhibitor is the correct path awaiting confirmation by ELISA and platelet release assay. If negati...
How would you treat an elderly patient with CD30 negative PTCL NOS involving base of tongue, vallecula and bilateral cervical lymph nodes?
This appears to be a stage II PTCL, NOS. Involvement of the tonsils, base of the tongue, and surrounding lymphoid tissue is considered nodal disease. If there is true involvement of the airway then it may be called "extranodal", but the treatment remains unchanged.Randomized studies are lacking/limi...
How do you approach adjuvant endocrine therapy in a pre-menopausal patient with node negative HR+HER2- breast cancer with a high Oncotype RS who received adjuvant chemotherapy?
The SOFT/TEXT study can be used to answer this question. SOFT was a phase III study in premenopausal women with ER+ disease comparing ovarian function suppression (OFS)+ an aromatase inhibitor (AI) to OFS + tamoxifen vs tamoxifen alone; TEXT compared OFS+AI vs OFS+tamoxifen. The vast majority of wom...
Would you recommend gastrectomy for a patient who has poorly differentiated adenocarcinoma in a resected gastric polyp?
This is a difficult question to answer as there is more information that I would need. I assume that the patient had cross-sectional imaging that was negative for metastatic disease. Was the polyp removed in its entirety at the time of polypectomy? I assume that all margins were negative. Are we sur...
How does the lack of mandated PET or brain MRI in the ADAURA trial impact your interpretation of the results?
The lack of mandated PET or brain MRI do affect study interpretation but I don’t think they change the bottom line. Lack of mandated PET (need for baseline PET scan has significant global variation) may understage some patients who might have occult local-regional or metastatic disease. This would i...
Would you give a HER2 targeted agent to a patient whose initial cancer was ER/PR positive, HER2 negative but now with metastatic disease that is ER positive, PR negative, HER2 2+, FISH equivocal?
Discordance of HER from primary to metastatic status is seen in about 5-10% of cases (1). Little data are available regarding outcomes of these cases, but responses have been seen in patients with HER2-negative primary tumors and HER2+ metastases (2), and I have certainly observed this personally. I...