Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
If using the triplet AMPLIFY regimen with ven/acala/obin upfront, what do you then plan to use in 2nd line treatment of CLL?
For patients who achieve a favorable response that lasts >1 year (or so, this is a ballpark estimate that may shift with more data), I would be very comfortable re-treating with a covalent BTKi (preferably after screening for BTK resistance mutations by NGS where available - with note of caution tha...
Do you get DEXA scans routinely before starting ADT for prostate cancer or endocrine therapy for breast cancer?
When initiating long-term ADT, I order a DEXA scan, check vitamin D level, ensure adequate dietary calcium intake, and discuss weight-bearing exercise/refer to PT when appropriate. I also continue check DEXAs every 2 years unless they otherwise meet criteria for a bone-modifying agent (mCRPC with bo...
Does postpartum status impact your choice of chemotherapy regimen for young women with a HR+/HER2- invasive ductal carcinoma with 1-3 positive lymph nodes?
No, the postpartum state would not affect my choice of adjuvant chemotherapy in a node-positive patient with HR+/HER2- breast cancer. Would submit tissue for Oncotype analysis to determine if the regimen should include an anthracycline (for Oncotype >30); if not, would favor TC x6 with concurrent ov...
In patients with T1 anal squamous cell cancer status post local excision with a close margin, would you recommend close observation or adjuvant concurrent chemoradiation?
I would solicit the opinions of my colorectal surgery and GI colleagues to see if re-resection (with TAMIS, for example) is possible. If it is not, I would likely observe. If the margin was positive and not just close, I would do traditional chemoradiation.
Does the possibility of future Lu-177–PSMA therapy change your current threshold to offer earlier metastasis-directed RT in oligometastatic prostate cancer?
There is a lot of excellent research being done on the efficacy and tolerance of combined Lu-177-PSMA therapy and EBRT. So far, the combination is well tolerated, and there is some data that sequencing the two to allow EBRT to treat the more “Pluvicto-resistant” lesions may help with efficacy.The qu...
Would you perform a bone marrow biopsy in a patient who had systemic anaphylaxis with hypotension to a stinging insect?
I would start with checking a serum tryptase and D816V mutation. Also, apply a REMA score and do a good skin exam. With normal tryptase and copy number, still check for KIT mutation.
How would you treat a young patient with an EGFR 19 deletion and a locally advanced lung mass who had a brain metastasis that was resected?
The technically correct, textbook answer would be 1st line EGFR therapy for metastatic NSCLC, which would be osimertinib + carboplatin/pemetrexed (FLAURA2) or amivantamab/lazertinib (MARIPOSA). However, given the unique circumstances here, I would treat this patient slightly differently.I've written...
In ES-SCLC presenting with limited asymptomatic brain metastases and treated upfront with systemic therapy alone (carbo/etop/atezo), how would you approach the brain if MRI shows PR after a few cycles?
In our practice, we would typically watch such a patient on systemic therapy. However, we would stress the need for vigilant monitoring and likely administration of RT (SRS ideally) at the carbo/etop/atezo transition to atezo monotherapy, given the poor intracranial efficacy of the maintenance syste...
How do you manage perioperative anticoagulation for a patient with a history of recent, surgically provoked VTE?
In most cases, bridging is rarely indicated because the bleeding risk usually outweighs the risk of VTE recurrence during a short (1–2 day) interruption of anticoagulation. However, after a recent VTE (defined as <3 months), the estimated risk of VTE recurrence is high (>15–20% per year) (still low ...
Does receiving IVIG confound the result of SPEP and/or UPEP?
IVIG being a product of polyclonal immunoglobulins may ‘produce’ a monoclonal spike if the AUC is falsely calculated by the reader. IFE usually shows polyclonal banding but every now and then a monoclonal band is picked up. Being an IgG molecule with a 21 day halflife; and with the assumption that i...