Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Do somatostatin based therapies have any role in treating neuroendocrine tumors that are silent on octreotide scanning ?
Possibly...there seems to be an association between the intensity of uptake and response to somatostatin analogs (SSAs) in patients with G2/G3 NETs. Almost all express somatostatin receptors (SSTRs) to some degree. The big question is how you assess for the presence of receptors. Octreoscans have lo...
How would you approach a Follicular grade 1-2 NHL found on a terminal ileum biopsy with otherwise negative EGD and colonoscopy and contrast enhanced CT scan?
At our facility, we have treated a significant number of patients with low grade lymphoma isolated to a single fixed site within the GI tract with excellent long term results. It is worth considering a dose of 2400 rads to the involved site.
What is your threshold for transfusing platelets in an asymptomatic patient after autologous stem cell transplant?
My thresold for transfusing platelets in an asymptomatic patient after autologous stem cell transplant is the same as with other patients - transfuse for plts<10 unless febrile or if any bleeding complications, at which time the threshold would be higher.
Is there a role for PD-1 inhibitors for metastatic or locally recurrent cutaneous squamous cell carcinomas after failure of first line therapy, EGFR inhibitors?
Yes. response rate close to 50%. Look at ASCO abstract from 2017 phase 1 looking at new PD-1 inhibitor in treat this disease
Would you do ALND for low ER pos (1-10%), Her2 + patient with positive sentinel lymph nodes?
The question whether an axillary lymph node dissection is therapeutic or diagnostic has not been completely addressed. Data is supportive that a complete lymph node dissection is not necessary in a ER+lower risk group of women undergoing a lumpectomy with radiation For HER2 positive patients and w...
Do you have a preference for a CDK4/6 inhibitor for first line metastatic HR positive breast cancer in combination with faslodex?
I do not have a preference for a CDK 4/6 inhibitor when given with fulvestran for metastatic ER+/Her-2 - breast cancer. Both palbociclib and abemaciclib are approved in combination with fulvestrant. There are differences in terms of dosing, schedule, and side effects. But, these features don't sugge...
Do you have any concerns about enhanced radiation toxicity with any of the novel agents used to treat multiple myeloma?
We use radiotherapy in myeloma sparingly. Generally, ONLY for end stage patients for which there is few to any systemic treatment options.That being stated, I am not aware of overt radiosensitization by novel agents. On the rare occasion that we do incorporate radiotherapy, we also rarely add potent...
How do you decide on the sequence of systemic and local therapy for patients with oligometastatic NSCLC?
Since patients are already metastatic, systemic progression is the deadliest threat to these patients, so systemic therapy is most important. It will help select out patients with favorable biology that may benefit from aggressive local treatment. The trial that showed a PFS benefit sequenced system...
Is further workup and management required for an incidentally found small focus of neuroendocrine tumor of the endometrium?
It depends on the grade and differentiation. Primary endometrial tumors are very rare and tend to be high grade and poorly differentiated. A lower grade tumor, especially an implant on the peritoneal surface, is much more likely to be a metastasis, most likely from a GI primary. A sample obtained at...
For patients with muscle-invasive bladder cancer and borderline renal function, would you consider use of a split-dose cisplatin/gemcitabine regimen for neoadjuvant treatment?
Yes, in patients with borderline creatinine clearance, e.g. 50-59cc/min, we tend to split cisplatin dose, e.g. 35 mg/m2 on days 1 and 8, if gemcitabine/cisplatin is used, or on days 1 and 2, if dd-MVAC is used. Also, we consider 24-hour urine testing to assess more accurately creatinine clearance in...