Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
What is the role of radiation in a patient with stage IV DLBCL with bilateral testicular involvement?
I tend to loosely recommend consolidation RT to the testicles in this situation if in CR. This recommendation is based on pattern-of-failure studies in primary testicular lymphoma where prophylactic contralateral testes RT is usually recommended, and the principle that the testicles are a sanctuary ...
How would you manage a middle aged woman with history of severe alcoholic liver cirrhosis and a small node negative ER/PR positive, HER2 negative breast cancer?
It is always critical to weigh absolute harms against benefits for any medical decision-making to the extent possible - ideally using validated tools when available/applicable. This should include factoring in co-morbidities and performance status. In the case of severe liver dysfunction - competing...
At what level of bone marrow disease would you agree to proceed with transplant for a patient with refractory AML?
Most transplant centers will settle on 5% or fewer blasts by morphology or flow cytometry as the cutoff for transplant. Exceptions or leeway is sometimes given for those undergoing myeloablative/full-intensity conditioning, and those with primary refractory disease. MRD typically refers to disease t...
What is the utility and recommendation for adding troponin and/or BNP to echocardiograms to screen for cardiac dysfunction In breast cancer patients receiving anthracycline based regimens?
For a healthy woman who received a total cumulative dose of 240 mg/m2 of doxorubicin, nothing more than a baseline echocardiogram is needed. JCO put out a clinical practice guideline in 2017 (Armenian et al., PMID 27918725) that covers the prevention and monitoring of cardiac dysfunction in survivor...
How do you approach patients with unresectable NSCLC planned for concurrent chemoradiation who develop a serious infusion reaction to paclitaxel?
There are a number of options to consider:1. Platinum-etoposide is a well-established regimen and alternative standard for concurrent chemoradiation for many years.2. For patients with nonsquamous histology, while the PROCLAIM study did not meet its study endpoint showing superiority compared to cis...
How do you approach using non-anthracycline based neoadjuvant treatment for triple negative breast cancer, especially in older patients with node negative disease?
There is compelling data that including carboplatin in neoadjuvant therapy for TNBC significantly increases pCR rates, and may allow omission of an anthracycline without compromising long-term outcomes. Until very recently, my anthracycline-free neoadjuvant regimen of choice was every 3-weeks doceta...
How would you approach therapy in a young adult with synovial sarcoma of the head and neck who is not amenable to surgery due to location on the face?
I do not think primary synovial sarcoma is curable without surgery. I have never seen a durable response in a tumor treated with radiation alone. Synovial sarcoma responds to ifosfamide based chemotherapy generally, but in my experience, the response rates for primary tumors are lower than response ...
Are you offering PARP inhibitor alone or both PARP inhibitor and bevacizumab maintenance for HRD+ ovarian cancer patients after upfront treatment?
If already giving bevacizumab for tumor-related reasons at initial presentation, would continue to maintain and add parp inhibitor, however, otherwise would use avastin later at recurrence, typically.
Is there any role for direct oral anticoagulants in the treatment of antiphospholipid syndrome?
Triple-negative APS is a confusing category as includes seronegative APS, APS with non-conforming aPL such as anti-phosphatidylserine-prothrombin amongst others, and the universe of patients with thrombotic events unrelated to antibody-mediated hypercoagulable state (eg Protein S, C or anti-thrombin...
What is your approach for treating transplant-ineligible patients with relapsed blastic plasmacytoid dendritic cell neoplasm (BPDCN) who have progressed on tagraxofusp?
First, I would have to wonder why the patient is not transplant-eligible. A lot of times we say this, but evaluation at the transplant center might find a patient is eligible for a nonablative approach. Second, I would strongly recommend the patient enter a clinical trial. The mustang biotech bpdcn ...