Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How does the presence of ascites affect your treatment planning for SBRT for HCC?
This is not an unusual situation in clinical practice, as it is common for HCC patients to have both benign and malignant liver disease. It is important to weigh the risks of aggressive SBRT in the setting of malignant ascites. In my practice, I find it is rarely the appropriate option. However, if ...
Are you comfortable using DOACs in obese patients with VTE?
Although there are no direct randomized trials in this population of patients, emerging data from systematic reviews suggest that DOACs are non-inferior to warfarin in patients >120 kg. (Elshafei et al., PMID 32556939).
How would you manage a localized melanoma of the anal canal with sphincter involvement, but without nodal or distant disease?
Anorectal melanoma is a rare entity and I have very limited experience. I summarized my experience in a different question on this forum "How would you approach a patient with clinical T3N1 anorectal malignant melanoma referred by a surgeon for neoadjuvant therapy?" For this patient in question, who...
What's the optimal management of stage IA nodal ATLL in a young fit patient?
It is a difficult question to answer. More data is needed to give recommendations: LDH, Ca, circulating ATL, lymphocytosis, etc. as it will be useful to sub-categorize her disease as lymphoma-type vs. chronic-type (favorable or unfavorable). It looks like you are treating her as a lymphoma-type whic...
How do you approach a patient with an anaplastic plasmacytoma without systemic evidence of disease in the bone marrow?
I'm not sure what an anaplastic plasmacytoma is. Is it a plasmacytoma that is made up of amorphous cells that express CD138, are clonal, and don't express EBER, ALK, or HHV8? This seems to follow along the lines of what is a plasmablastic neoplasm. If there are no clonal plasma cells in the marrow, ...
How would you manage adjuvant treatment of a premenopausal woman with HER2 positive, ER/PR negative multifocal micro-invasive node-negative breast cancer?
I would not typically recommend any adjuvant chemotherapy + HER2 directed therapy for a T1mi N0 breast cancer. For T1a, the risk of distant recurrence also is likely low based on observational series, so observation is also reasonable. However, as per NCCN guidelines, it is also appropriate to consi...
Assuming a clinical trial is unavailable, would you consider tazemetostat in a patient with metastatic INI1/SMARCB1 deficient sinonasal carcinoma?
I would certainly consider Tazmetostat for INI deficient SNUC, if progressed on front-line therapy and no trials available.
Does discovery of clonal hematopoiesis on liquid biopsy for solid tumors change your treatment approach in terms of which chemotherapy to offer for the solid tumor?
CHIP findings are relatively common. A small percentage of patients with CHIP abnormalities will evolve into a Hematological malignancy depending on the mutation in the 1-2% range. I am unaware of any data that indicates that this percentage increases due to treatment for solid tumors. Therefore, I ...
Does cytoreductive therapy in high risk PV reduce thrombotic events because of better normalization of blood counts as compared to phlebotomy, or through some other mechanism?
I suspect that several factors contribute to the decrease in thrombotic events. First, more consistent normalization of blood counts. However, probably more importantly is the reduction in inflammation. This would be supported by the lower thrombotic events in patients on ruxolitinib vs standard the...
What treatment would you consider for metastatic urachal carcinoma following progression on FOLFOX and FOLFIRI?
Metastatic urachal adenocarcinoma is a challenging disease to treat with significant unmet needs. Initial therapy replicates therapy for metastatic colorectal adenocarcinoma and may include FOLFOX, FOLFIRI or FOLFOXIRI potentially combined with bevacizumab. Salvage therapy may include 1) trials (gui...