Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
What is the preferred treatment approach for an AYA patient with intermediate to high risk Hodgkin lymphoma: The pediatric approach (ABVE-PC +/- radiation) or the adult approach (ABVD with possible escalation to BEACOPP)?
The question of which regimen is preferred needs to be individualized for a given AYA patient. The recent development of pediatric specific NCCN guidelines with some overlap with adult guidelines for Hodgkin Lymphoma can provide a guide. The acute toxicity tradeoffs of myelosuppression with ABVE-PC ...
How would you manage an incidental catheter-related thrombosis in a functioning dialysis catheter?
If the patient is asymptomatic and the catheter is functioning well, I recommend starting anticoagulation.If the patient develops symptoms, he or she should still be anticoagulated but the catheter removed. Anticoagulation options in ESRD patients include Coumadin, Eliquis (my preference is a dose o...
Would you consider use of upfront BV plus nivolumab to treat Hodgkin Lymphoma in elderly patients unable to receive standard chemotherapy?
I would definitely consider BV/Nivo in frontline settings for elderly patients if no trial is available.Prognosis is worse in elderly HL for several reasons - SOC chemotherapy is not well tolerated and biology of the disease is different (mixed cellularity being prevalent and more frequent EBV posit...
After completing 6 cycles of docetaxel plus ADT for metastatic hormone-sensitive prostate cancer per CHAARTED, are there clinical scenarios in which you would add an additional AR targeted agent (ex: enzalutamide, abiraterone, or apalutamide) to ADT?
This is an important question and has in part been asked as part of subgroup analyses of the phase 3 ENZAMET, ARCHES, and TITAN mHSPC trials. In these trials, there was clinical benefit observed with combined chemohormonal therapy AND potent AR inhibition, sequentially in ARCHES/TITAN, and in combin...
How would you approach treatment of a bulky stage II DLBCL in a patient >80 with a contraindication to anthracyclines but otherwise good performance status?
The management of DLBCL in the elderly, particularly those unfit for standard anthracycline-based chemoimmunotherapy, is an area of unmet need and clinical challenges. While there is no single standard of care, and participation in clinical trials designed for this patient population is encouraged, ...
Would you ever offer adjuvant immunotherapy after definitive chemoradiation for esophageal cancer?
A great question – one that we really don’t have data to answer quite yet. Obviously, we do have guidance for resectable patients. CheckMate 577 was a randomized, double-blind, placebo-controlled phase 3 trial in patients with stage II or III esophageal or gastroesophageal cancer who received neoadj...
At what lower end of recurrence risk do you offer adjuvant imatinib for patients with resected GIST?
The "lower end of recurrence risk" justifying adjuvant Imatinib is indeed a personalized decision between the provider and the patient based on risk-tolerance on both sides. In the absence of "cost-effectiveness" data, this has to be a mutual decision that works for both sides. In general, <20% risk...
Do you check pertussis serologies when sending labs for antiphospholipid syndrome?
The short answer is no. I do not check pertussis antibodies when evaluating patients for anti-phospholipid syndrome. A slightly longer answer is still no and, for example, a review published in the Annals of Rheumatic Diseases by Ron Asherson in 2003 discussing the relationship between various infec...
When can defibrotide be discontinued before the 21-day treatment course is completed in a pediatric patient with SOS?
There is no data to support the 21-day use in everyone. Also, some patients might even need a longer course than the prescribed 21 days if manifestations are ongoing. A good general rule of thumb would be to continue (provided no bleeding or other toxicities) for 3-5-7 days post resolution of ong...
For a patient with metastatic NSCLC who had progression x2 at a single site treated w RT, would you switch systemic treatment?
Continue immunotherapy.