Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Would you recommend adding Debio 1143 to high-dose cisplatin chemoradiotherapy in high-risk locoregionally advanced squamous cell carcinoma of the head and neck?
At this point, I will still refer LAHNSCC patients to the phase-3 clinical trial randomizing patients to placebo vs Debio-1143.
How would you approach a patient with newly diagnosed hepatocellular carcinoma with very high AFP (>100,000) but no clear radiographic evidence of metastatic disease?
This is a challenging situation. Oftentimes, these patients have significant vascular involvement of their tumor. AFP has been shown to correlate with survival and those with markedly elevated (>100,000) have a very poor prognosis (REACH, REACH2, Zhu et al., PMID 33531690). If a patient has known HC...
How long do you give systemic therapies or skin directed therapies to work before changing treatments in patients with diffuse skin limited mycoses fungoides?
It really depends on the patient, the side effects profile. Some systemic therapies are “skin directed” like bexarotene. Also, access to a dermatologist's office for nbUVB is an important factor in making such a decision. I generally don’t recommend topical agents when there is more than 10% eBSA sk...
Would you avoid cisplatin with etoposide in a patient getting chemoradiotherapy for stage III non-squamous NSCLC who has a history of CABG 4 years ago and echocardiogram showing left atrial dilatation?
In short, I would avoid cisplatin here. The main issue with cisplatin is the need for fairly aggressive hydration to avoid nephrotoxicity. Generally, at least 1-2 L IV NS hydration is given, however, some will give up to 3L, in addition to the volume infused with actual treatment (usually diluted in...
Do you routinely offer doxycycline or minocycline prophylaxis for cutaneous reactions to EGFR inhibitors such as cetuximab?
When we use EGFR inhibitor for colorectal cancer, we routinely use the STEPP regimen that showed significant benefits in the phase II study including skin moisturizers, sunscreen, topic steroids, and doxycycline. In the phase II STEPP study, using this pre-emptive treatment significantly decreased s...
What is the role of splenectomy versus systemic therapy in splenic marginal zone lymphoma?
With the introduction of rituximab and other CD20 monoclonals, the role of splenectomy in splenic marginal zone lymphoma is shrinking. There are rare clinical scenarios where I would still recommend splenectomy in splenic marginal zone lymphoma; huge splenomegaly with disabling symptoms, splenic tra...
Would you restart endocrine therapy for a patient with new contralateral LCIS diagnosed 2 years following completion of AI therapy for stage 1A HR+ IDC?
The primary prevention trials (NSABP-1, STAR, etc) largely excluded women with a prior history of cancer and certainly did not include those who'd had 5 previous yrs of endocrine therapy. While I think you could discuss an additional 5 yrs of endocrine therapy, an additional 5 yrs of AI (e.g. 5-10 t...
In what clinical scenarios do you utilize venetoclax-based therapy in relapsed/refractory multiple myeloma?
I would caution that there is no strong data that the combination of Venetoclax with a proteasome inhibitor or a CD38 antibody makes sense; in fact, the addition is more likely than not to cause harm. Adding on to Venetoclax in patients that are naive to proteasome inhibitor or CD38 Ab naive is jus...
In what scenario would you add systemic therapy with adjuvant radiation therapy in resected, locally-advanced, cutaneous squamous cell carcinoma?
This is an active area in clinical trials, here is a recently published reviewNewman et al., PMID 34096664 More to come in a future post, I will see what trials are currently available in the Chicago area!
Why do we use dexamethasone for CNS edema and prednisone for pneumonitis?
Dexamethasone has better CNS penetration compared to prednisone and thus its established use for managing vasogenic edema. However, it has the most suppressive effect on ACTH, causes relatively more steroid myopathy and has less mineralocorticoid effect compared to prednisone hence, the general use ...