Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
What are your top takeaways in Melanoma from ASCO 2022?
1. Melanoma oral abstract session #3: Abstract 9502 Neoadjuvant PD-1 blockade in patients with resectable desmoplastic melanoma (SWOG 1512)Desmoplastic melanoma is a rare subtype of melanoma that frequently occurs in the head/neck area and is very difficult to completely resect due to its invasivene...
How would you approach therapy for a patient with a history of classical HL who achieved a CR to 6 cycles of Brentuximab plus AVD who now presents with widespread non-GC DLBCL?
Depending on the time from initial treatment, age, and the patient's fitness, could consider several options. If it has been within a short interval, then would be concerned that the DLBCL was present during or shortly after exposure to anthracycline. In that case, would treat with R-CEOP with cons...
What could explain the discordant results between PARP/abiraterone combinations in MAGNITUDE and PROpel in non-HRRm prostate cancer?
This is an important question. I would summarize this below: 1. Differences in study design and patient populations MAGNITUDE allowed prior ARSI (5%), prior exposure to abiraterone for up to 4 mo which could have been selected for patients less sensitive to abiraterone where PARPi combination syner...
In the setting of platinum resistant ovarian cancer, do you consider repeat use of bevacizumab with subsequent lines of chemotherapy following prior treatment with chemotherapy + bevacizumab with bevacizumab maintenance?
I typically do reuse bevacizumab. Now that bevacizumab is approved for front-line, maintenance, and recurrent settings, many patients with recurrence may not be bev-naive, to begin with, and I still use bev+chemo.In breast cancer (von Minckwitz et al., PMID 25273342) and colon cancer (Bennouna et al...
Are there any situations where you would consider neoadjuvant chemoradiation as opposed to chemoimmunotherapy for patients with resectable NSCLC prior to surgical resection?
For most of the last 2 decades, there has been a raging debate about the best perioperative approach for the management of patients with high-risk resectable NSCLC, such as patients for example, with preop documented nodal disease. Clinical studies have not been able to settle the key questions whet...
What is your preferred first line regimen for myeloma with severe renal impairment, either on or off dialysis?
In general, for patients with renal insufficiency related to their myeloma, time is nephrons. So the earlier you can correct the hypercalcemia, lower circulating uric acid, stop ongoing bad behaviors (NSAID overuse, etc), and treat the myeloma, the better. If the patient is admitted, I will give pa...
Among non-HRRm castrate resistant prostate cancer patients, are there features predictive of response to PROPEL regimen of abiraterone/olaparib?
There is a theory that abiraterone can lead to changes in the tumor that could make it susceptible to PARP inhibitors. I understand that the clinical trial suggests that this may be the case, but I think we need more information as to whether or not this is actually happening.
In a patient with extensive stage small cell lung cancer and a neurologic paraneoplastic syndrome do you feel comfortable using an ICI along with the chemotherapy?
I have not used immune checkpoint inhibitors (ICI's) in patients with SCLC that have neurological paraneoplastic syndromes. These syndromes can be quite debilitating and given the risk of exacerbation of the symptoms by ICI use, I have not used them in this setting. One has to remember that the use ...
What criteria does your institution use to indicate patient is ready for PEG tube removal?
The short answer is we typically advise patients that if they can maintain an oral diet (using the tube for flushes only) for 2 weeks and demonstrate no weight loss they are typically ready for tube removal. Our patients though are followed through the course of their treatment by a dietician, and t...
Are there any differences in your approach to therapy for secondary versus primary myelofibrosis?
Good question. I will risk stratify patients with secondary MF using the MYSEC-PM score and primary MF patients using DIPSS+ or MIPSS. Anecdotally, patients with secondary MF tend to have more indolent MF and there is definitely a grey zone period when you know they are transforming but still doing ...