Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Would you consider switching endocrine therapies for a peri-menopausal woman on adjuvant tamoxifen solely due to an estradiol level if this was checked and found to be significantly elevated?
I agree with Dr. @Dr. First Last that this is likely ovarian hyperstimulation from tamoxifen which can occur in 9-17% of women and is more likely to occur in younger women treated with tamoxifen therapy alone. In one study, a level of over 300pg/mL and follicular diameter over 30mm were used to defi...
What is your approach to the treatment of metastatic renal cell carcinoma with unclassified histology?
The key to managing unclassified renal cell carcinoma is to obtain a detailed histological and molecular characterization. Clarify with pathologist(s) regarding unclassified nature - are there some features characterizing the tumor as being of a recognizable subtype? Next generation sequencing to de...
How do you approach staging and treatment for a p16+ nasopharyngeal SCC?
First question is whether it is strictly p16 positive and confirmed EBER ISH negative. If so, I treat it like p16 positive oropharyngeal cancer with chemoradiation. I don't give adjuvant chemo. All the adjuvant chemo or induction chemo data is for EBER ISH positive nasopharyngeal carcinoma.
How would you treat high grade urothelial carcinoma of the prostate with only HGUC with CIS in bladder?
The optimal peri-operative systemic therapy for non-contiguous UC involving the prostate is unclear due to lack of high-quality prospective data. One key aspect of staging and evaluation would be to further evaluate the depth of involvement and exclude stromal involvement by the prostatic UC. Prior ...
What hematologic conditions are contraindications for a COVID vaccine?
The short answer is that a history of severe allergic reaction is really the only contraindication to COVID-19 vaccination. Perhaps, patients with systemic mastocytosis might be at increased risk of allergic reaction but I'm not aware of data to support that.The longer answer is a question of timing...
Would differentiating between embryonal vs alveolar rhabdomyosarcoma of the nasal cavity change your neoadjuvant chemotherapy regimen or make you consider neoadjuvant radiation in a locally advanced pleomorphic RMS?
The historic Embryonal vs. Alveolar differentiation is being replaced by a (PAX-FOXO) fusion positive vs. negative classification given the prognostic significance. In either case, the chemotherapy regimen is not likely to change in an adult patient. Pleomorphic RMS on the other hand, more common in...
Would concurrent endocrine therapy and PARPi maintenance be safe and appropriate after surgical treatment/adjuvant chemotherapy for a patient with BRCA1 mutated synchronous early stage HR+ breast CA and Stage IIA Fallopian tube carcinoma?
This does seem like a reasonable approach, based on my knowledge of eligibility criteria and tolerance in the OlympiA trial, which was a randomized trial of olaparib vs placebo in BRCA mutation carriers. In the OlympiA trial, patients with BRCA 1/2 mutation and hormone receptor positive breast cance...
When do you check for EPOR gene mutations in your workup for erythrocytosis, and if found, how do you manage it?
Only consider it in instances where there is a life-long (or at least long-term) erythrocytosis and there is no evidence of a secondary erythrocytosis. There is no role for ASA or HU in these instances. I generally do not use phlebotomy either, unless the hematocrit is extreme and the patient is sym...
For an otherwise healthy post-menopausal woman with early stage HR+ BC and persistent AI intolerance, is there an age cutoff above which you would consider avoiding adjuvant tamoxifen therapy?
There is no age cut-off based on chronological age. However, physiologic age and comorbid conditions are what I would use. For example, a 72 yo with diabetes, hypertension, and coronary artery disease is likely to die of her underlying conditions and not early stage breast cancer (Ording et al., PMI...
What is the best approach to organ confined squamous cell cancer of the prostate?
This is a very unusual situation in the US and other developed countries. Most of the patients with this histology tend to have other chronic illnesses to the pelvis prompting the development of this chronic inflammatory driven disease. As such, they can represent difficult situations to treat. From...