Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Would you consider surgical management of a TNBC primary after a patient has had radiographic resolution of oligometastatic disease?
Randomized studies have revealed no advantage with removal of primary; however, there is a growing body of evidence in other cancers for treating oligo-metastatic disease with curative intent. Breast cancer is not colon cancer, etc but I feel the concept is novel and in the era of highly effective s...
How long would you continue chemotherapy for resectable pancreatic cancer not amenable to surgery due to functional status or comorbidity?
I think it depends upon the severity of functional limitations and comorbidites. If the patient can tolerate systemic therapy, I would favor the use of radiotherapy after an initial trial of systemic therapy (duration purposefully vague as it would be dictated by tolerance). I’ve generally favored S...
In which patients with oncologic or hematologic disorders are you recommending a 3rd dose of mRNA COVID vaccine?
In the ideal world, we would tailor the need for booster shots based on whether or not a patient achieves an appropriate immunologic response and maintains that response for long periods of time. This would include both seroconversion and T-cell-mediated immunity. However, we have neither routine no...
Will you consider adding an AR targeted agent to ADT for a patient thought to have isolated pelvic nodal recurrence of prostate CA if next generation imaging reveals additional non-regional disease not seen on conventional imaging?
There are no formal prospective trials addressing the question of timing (i.e. initiation of systemic therapy) based on metastasis identified on molecular only imaging. The best data available is based on the three trials in non-metastatic castration-resistant prostate cancer (PROSPER, ARAMIS, and S...
Would you consider adjuvant olaparib in a premenopausal female with TNBC with high risk features and germline BRCA1 mutation who achieved pCR after neoadjuvant chemotherapy?
I would not, as these patients were not allowed to go on OlympiA. Their residual risk of TNBC relapse after PCR is low so the absolute benefit of olaparib for a year (if any) is also going to be low.
Given results of the ELEVATE-RR study, would you consider use of acalabrutinib in all patients with previously treated CLL, or restrict it to certain patient populations?
Efficacy and safety are both important for evaluating new therapies. The ELEVATE-RR study demonstrated equivalent efficacy with a hazard ratio of 1.0 which indicates response duration was identical. Notably, several indications of safety were better which then would tilt the benefit to using an alte...
Does multiple myeloma become more radioresistant post transplant?
Anecdotally, I had a recent myeloma patient who developed progressive chest wall disease after ASCT and numerous prior rounds of therapy. I gave him 8 Gy in one fraction to two chest wall sites; one had a partial response before progressing months later, the second site progressed through RT with no...
In the rare setting of enoxaparin injection-induced abdominal wall hematoma in patients requiring long-term anticoagulation, what is your timeline for restarting anticoagulation?
Abdominal wall hematomas typically occur when a vessel has inadvertently been injured during injection. Timing of resumption of anticoagulant will vary with the underlying indication for anticoagulants. For a high-risk indication, eg multiple cardiac valves in patients with history of stroke, I woul...
What is your approach to the management of hot flashes in a patient who wants to use herbal medicine?
Hot flashes are so bothersome to some postmenopausal women, especially those with breast cancer in whom we discourage the use of estrogen or potentially estrogenic, that we now have evidence from randomized trials to help guide treatment. With regard to nonprescription therapies, data thus far suppo...
What is your approach to CLL in patients with atrial fibrillation and/or on anticoagulation?
Before the availability of venetoclax, the only approved targeted oral therapy for patients with CLL was ibrutinib. Given the lack of alternative options, patients with atrial fibrillation and/or patients on anticoagulation were treated with ibrutinib. Use of anticoagulation with ibrutinib can incre...