Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How do you manage endocrine therapy in patients on tamoxifen who develop thrombophlebitis but not DVT?
In a patient on tamoxifen, the risk of clot extension into the deep system is higher than average. In such scenarios, the recommendation is to use anticoagulation for at least 6 weeks (consider 3 months if no improvement noted at 6 weeks). Tamoxifen should be held for the first 3 weeks, consider res...
Do you recommend anticoagulation for a splenic infarct in patients with myelofibrosis and splenomegaly?
I generally do not recommend anticoagulation for a splenic infarct in patients with MF and splenomegaly. The situations where I would anticoagulate: ff they have a splanchic vein thrombosis, or clear evidence of embolic disease (i.e., other areas affected in addition to the spleen). However, general...
What is the best treatment approach for fit, young patients with extraskeletal Ewing Sarcoma in the lung?
A thorough staging workup should be completed to ensure there is no subclinical primary tumor and that the lung lesion is not a metastasis. Extraskeletal Ewing sarcoma is treated the same as a primary Ewing sarcoma of bone with dose dense vincristine, doxorubicin, cyclophosphamide (VDC) alternating ...
How do you determine when to give a second CAR-T cell infusion to a pediatric or young adult patient with relapsed/refractory ALL?
Anti-CD19 CAR-T cell therapy has the capacity to induce high rates of clinical response in heavily pre-treated patients for CD19 expressing B-cell malignancies. Among those, B-cell ALL is a poster child for CAR T cell therapy given the propensity for inducing high rates of MRD-negative complete resp...
What systemic therapy would you choose for elderly patients with HER2+ breast CA who have early metastatic relapse (within months) of completing adjuvant trastuzumab/paclitaxel?
Yes, even our frail older patients may have pretty aggressive HER2+ cancers. I am treating a lovely older lady who is on her 6th line of therapy and has responded to everything she's had, so far! We've been working together for about 7 years! Initially, I stuck to pretty standard regimens with dose ...
What is your regimen of choice for metastatic papillary renal cell carcinoma?
My regimen of choice for papillary RCC is cabozantinib given recent evidence. Papillary renal cancer has not had a standard established therapy until recently. Most of the clinical trials in kidney cancer restricted eligibility to clear cell carcinoma component. SWOG 1500 reported results of a rando...
How do you approach the treatment of patients with widespread ES-SCLC with a poor performance status?
My basic philosophy for the initial treatment of people with ES-SCLC (or LS-SCLC) with poor PS is to just try to get them going in the right direction without killing them with my treatment. SCLC is usually very responsive to chemotherapy, so you don’t have to beat people with full doses of the drug...
Do you routinely add endocrine therapy to anti-HER2 maintenance therapy after 6 cycles of THP for metastatic ER+ HER2+ breast CA?
Yes, if I am treating triple positive, I generally add ET to HP regardless of whether the patient received THP or not. The therapeutic window is wide, and likelihood of cross-talk interfering with long-term anti-HER2 effectiveness is high. While not tested systematically, HP alone is likely a relati...
Would you consider stopping maintenance immunotherapy for ES-SCLC after 2 years for exceptionally responding patients?
If therapy is well tolerated, I support indefinite use. While it is rare to see late recurrence in NSCLC after 2 years, I have seen late recurrence regularly in SCLC.
How would you time COVID-19 vaccination with someone on R-CHOP chemotherapy?
It is really hard to time COVID vaccine while on chemo. Although ideal time would be as far away from chemo as possible (3-6 months) or 6 weeks before chemo starts, that is not practical in someone getting q 3 week R-CHOP. I would recommend giving it when available and if possible, time it on a diff...