Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How would you manage a stage IE DLBCL of the stomach, non-germinal center type by IHC, and Ki-67 of 70%, but negative for double/triple hit by FISH?
Nijland et al., PMID 29083044. This shows that you can use either option, 3 cycles RCHOP+ XRT or 6 cycles RCHOP with no difference in relapse or DFS.My bias would be to treat with 6 cycles of RCHOP as I look at DLBCL as a systemic disease and risk for systemic relapse even with early presentation.If...
When do you consider iron chelation in elderly patients with transfusion-dependent MDS?
When the ferritin is >1500 or if LFTs due to iron are abnormal between 1250-1500. You have to be careful with chelation at lower levels due to chelation of other micronutrient heavy metals.
Would you initiate chemoimmunotherapy (e.g. RCHOP) in a symptomatic patient with DLBCL who tested positive for COVID19?
It will depend on if he is symptomatic from covid infection or just positive but asymptomatic. If asymptomatic from covid, I would treat. DLBCL is the one which is symptomatic and active disease without treatment is equally immunosuppressive. I would suggest giving rituximab with cycle 2 rather than...
How would you manage an incidentally identified 1.0 mm anal squamous cell carcinoma (5.5 mm margin) in a background of severe dysplasia/CIS involving the peripheral excision margins found on a hemorrhoidectomy specimen?
T1 anal margin cancers can be adequately treated with local surgical excision if negative margins (> 1cm) can be accomplished without compromise to the adjacent sphincter muscles and no evidence of nodal involvement. In this specific case, I would recommend thorough examination via anoscopy with bio...
How would you manage a patient with early stage ER+ HER2+ breast CA who cannot receive definitive local therapy due to severe cardiopulmonary co-morbidities?
My management would depend on the nature of the severe cardiopulmonary co-morbidity and the clinical stage of the disease. For someone who is not a candidate for surgery (even with local axillary block, etc.), but does not have a cardiomyopathy, and is otherwise fit for systemic therapy (ECOG PS 0-2...
Would you ever consider prophylactic anticoagulation in patients with CKD requiring ESA therapy?
I would not start anticoagulation in this setting solely because the patient is to receive ESA treatment, but would advocate for adjusting the ESA dose to maintain a hemoglobin of 9-10 g/dL, since a number of studies suggest that targeting higher hemoglobin levels is associated with increased risk o...
Would you consider using a PARP inhibitor in a patient with metastatic pancreatic cancer with a germline ATM mutation after progression on FOLFIRINOX and gemcitabine based chemotherapy?
I would not use a PARP inhibitor in this situation. The available evidence on PARP inhibitors in pancreatic cancer is in the first-line maintenance setting, among patients with germline BRCA mutations (and now also among patients with somatic BRCA mutations and with germline PALB2 mutations). So cur...
Do you alter your surveillance plan after achieving local control for patients with breast CA with locoregional recurrence given the higher risk of distant recurrence?
The data regarding best surveillance strategies for patients with locoregional recurrence is limited. Patients who recur with extensive locoregional involvement but are salvaged with systemic and local therapies are at very high risk of relapse. Therefore, for such patients, I am leaning towards sur...
How do you approach therapy for a fit adult with relapsed AML with CNS involvement after allogeneic stem cell transplantation?
Agree with Dr. @Dr. First Last. If on immunosuppression, would stop immunosuppression. HIDAC q12 hours x 5-6 days reinduction is a regimen that can be used for relapsed AML. There is some data in adding venetoclax to chemo induction and should be considered.If starting venetoclax single agent to add...
What gemtuzumab regimen and schedule (with standard 7 plus 3) would you use for a newly diagnosed AML patient with favorable genetics?
Per the ALFA-0701 trial, we administer GO (3 mg/m2, capped at 4.5 mg vial) on days 1,4, and 7 of induction therapy with 7+3.