Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Under what circumstances would you consider outpatient induction for AML?
At some centers, I know that induction with venetoclax and azacytidine/decitabine/low dose cytarabine or liposomal cytarabine/daunorubicin (CPX-351) for patients with newly diagnosed AML has been administered in the outpatient setting. However, in these centers (such as Moffitt Cancer Center), there...
How do you choose your systemic treatment for primary mediastinal grey zone lymphomas?
Most of the literature (although not prospective) supports treating with an R-CHOP/EPOCH vs. traditional ABVD. As such, I tend to treat with R-DA-EPOCH. When I have had the unfortunate case of a relapsed/refractory patient, I have tended to treat with some of the newer HL salvage regimens.
Is it essential to wait one week after loading dose of erbitux to start RT for head and neck cancer?
I would start RT if it means you're going to risk delaying RT start window. Another question is, why are you giving Erbitux for post-op treatment? Can you use another agent?
How do you counsel patients on JAK inhibitors about the risk of venous thromboembolism, MACE, and cancer?
I advise patients that there remain many unanswered questions regarding these side effects that will be resolved with longer term use with these agents. Shared decision-making is critical for these discussions. Data available from current extensions of clinical trials for JAKi, additional risk facto...
Is tumor deposit (N1c) alone an indication for adjuvant chemoRT for rectal cancer that did not receive neoadjuvant therapy?
Some patients such as this were undoubtedly included in the early rectal cancer trials [GITSG and Mayo North Central (NCCTG)] that established the role of post-operative chemoradiation for stage II and III rectal cancer. However, accrual numbers were too small for stratification of TN subsets and it...
How do you manage ALK-inhibitor AEs which are low grade but significantly impact patient QOL over time?
How to manage ALK directed therapy adverse events that are low-grade but significantly impair quality of life remains a challenge. Some of these adverse events include fatigue, nausea, rash, and loss of appetite. More often than not, these side effects are not pronounced but over time can impair qua...
How do you approach a patient with discordant mutation testing in liquid vs tissue biopsy for mNSCLC?
The recent advent of liquid biopsy testing for patients with advanced non-small cell lung cancer has generated a tremendous amount of enthusiasm and has altered the diagnostic algorithm for patients. We now have data that shows that liquid biopsies are reliable, are accurate, and can inform treatmen...
What treatment would you offer for a patient with unresectable triple negative breast CA who remains unresectable after completion of dd AC-T?
If the patient was responding to treatment but maybe presented with a large mass and had an insufficient response to chemo to convert her to resectability, further chemotherapy with carboplatin, preferably in combination with another agent - and I wouldn't rule out using docetaxel, given the activit...
For a patient with distal esophageal adenocarcinoma with residual disease after FOLFOX x3 cycles + RT followed by surgery, would you recommend adjuvant chemotherapy or adjuvant nivolumab?
CM577 has simultaneously done 2 things: established nivolumab as a standard-of-care in this setting but also hopefully discourages/eliminates the use of adjuvant chemotherapy. There are absolutely no data to justify giving more or different chemotherapy to such patients. Remember, the control arm of...