Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How do you approach chemotherapy dosing in extremely obese patients?
Our approach to chemotherapy dosing for overweight and obese patients remains as we recommended in JCO 2012 by Griggs et al., PMID 22473167. Most overweight and obese patients should be dosed with cancer chemotherapy based on their actual body weight/BSA and any dose reductions should be made as you...
How would you sequence therapies for a patient with chemotherapy-naive metastatic castration-resistant prostate cancer who is MSI-H on tissue-based NGS?
Yes, I absolutely would use Pembrolizumab (200 mg IV q3wk, or 400 mg IV q6wk) in a MSI-high patient with mCRPC who has not yet received chemotherapy. However, I would probably postpone this until after the patient has progressed on one novel AR-directed therapy. I think that the "sweet spot" for usi...
When would you recommend adjuvant therapy for a patient with urethral adenocarcinoma after partial urethrectomy?
My first approach in this setting is to have the pathology reviewed by an expert tumor pathologist, and to be sure of the T stage, margins, N/M stage, and whether any tumor markers are heavily expressed. If there is a strongly expressed tumor marker, such as CEA, I will obtain baseline, and interval...
How do you approach adjuvant therapy for a premenopausal patient with a pathologic BRCA1 mutation whose TNBC had a complete response to neoadjuvant chemotherapy except for an ITC in one LN?
This is technically a Stage 0/RCB-I after neoadjuvant chemo when I calculated it. This patient would not qualify for the current clinical trials looking at additional therapy (ECOG capecitabine vs platinum, now closed; the SWOG pembrolizumab vs observation, still accruing). Looking at CREATE-X, the ...
Should targeted therapies such as Brentuximab or Crizotinib be used in the upfront management of anaplastic large cell lymphoma in a pediatric or AYA patient?
Good question. Importantly, I am assuming that the question is for ALK+ patients who have systemic disease because ALK inhibitors have no role in ALK- disease and cutaneous only ALCL is really an entirely different entity.In fact, the question is the primary aim of COG trial ANHL12P1 which uses eith...
How do you approach contraception and pregnancy counseling in women of childbearing age with Desmoid tumors who may be contemplating future pregnancy?
Sporadic desmoid tumors have a propensity (80% of cases) for women of childbearing age and they do seem to come up during and after pregnancy. Here are my thoughts on contraception and pregnancy for women with desmoid tumors.1. Norethindrone pill. This is not specific to people with desmoids. I am a...
What surveillance imaging do you obtain for stage III melanoma patients after completing systemic adjuvant therapy?
I agree with Dr. @Dr. First Last. The guidelines for surveillance allow some personalization based on patient specific characteristics. For stage III melanoma patients on adjuvant therapy (or not), we scan with CT scans every 3 months for 2 years, every 6 months up to 5 years. If there is something ...
How would you treat a patient with widely metastatic penile squamous cell carcinoma with mixed response to 4 cycles of TIP chemotherapy?
Penile squamous cell carcinoma (PSCC) is a challenging and rare malignancy. In those with metastatic disease following therapy with cisplatin-based combination chemotherapy, there are no optimal or approved options. Clinical outcomes are dismal with currently used salvage therapy agents. Cetuximab o...
What first line regimen for metastatic esophageal or GEJ adenocarcinoma would you use in an elderly patient (>80) with medical comorbidities?
I believe that there is no one right answer to this question. Elderly patients with chronic health problems require a full assessment before considering a particular treatment regimen. By "full", I mean learning as much about them as possible, including not just their performance status, renal funct...
Do you routinely check platelet counts after COVID-19 vaccines in patients with chronic ITP?
Yes. the side effects of COVID vaccines are still evolving. Mild to moderate thrombocytopenia was noted and severe thrombocytopenia is extremely rare. I would follow an abundance of caution and do weekly complete blood counts, especially in the ITP patient.