Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How has the virtual aspect of tumor boards impacted their educational quality in the Covid-19 era?
In my experience, tumor boards serve 2 purposes. Firstly, they are designed to bring multiple specialists and cancer providers together in real-time to facilitate patient care. Secondly, they help educate the various disciplines based on a robust interaction. Virtual conferences are complicated by d...
What is the optimal treatment for a fit, elderly patient with NGC diffuse large B cell lymphoma that recurred about 1 year after dose-attenuated R-CHOP?
There are a number of appropriate options to consider depending on the specifics of the case. Could the patient be eligible for axi-cel? 2L CAR-T is appropriate for fit elderly patients so long as they fit eligibility for CAR-T and have access, and axi-cel is approved for early relapse/refractory pa...
How do you discuss curative vs palliative treatment intent for patients with favorable risk 1p/19q co-deleted oligodendrogliomas?
Although my name is on a publication calling low-grade oligodendroglioma an "incurable disease", this is not a term that I use with patients — even in the case of glioblastoma. We do not have a published 20-year follow-up of RTOG 9802 to see if there is a plateau in PFS. Are we only delaying inevita...
How does tumor stage affect your choice of adjuvant chemotherapy in pancreatic cancer?
I have moved my practice for resectable PDAC (and certainly borderline resectable tumors) almost entirely to neoadjuvant therapy. The SWOG S1505 study (see links below) has shown that either gem/Abraxane or FOLFIRINOX is appropriate. In the adjuvant setting, there is better data for FFX and gem/cis ...
How do you manage a patient with a history of high-risk leukemia who has increasing loss of donor chimerism in the post-transplant setting in the absence of disease relapse?
Decline in donor chimerism is not very common in pediatric patients who underwent myeloablative conditioning regimen for hematologic malignancy, and if chimerism is initially 100% and subsequently falls, it usually represents a relapse of underlying leukemia, or a new malignancy. I always obtain lin...
Would you offer adjuvant chemotherapy to a patient with high grade pT1 bladder cancer with concurrent pT2 prostatic urethral stroma involvement?
I would adopt the data from the CheckMate 274 trial. If the patient is post-neoadjuvant cisplatin-based chemotherapy, I would consider adjuvant nivolumab, especially if the tumor PD-L1 is high and/or post-op ctDNA is positive for minimal residual disease. If the patient has not received neoadjuvant ...
Do you obtain biopsies to confirm positive DOTATATE PET scans during surveillance or treatment?
The answer to this question all depends on the clinical scenario. Modern-day SSTR PET imaging (Ga68 DOTATATE, Ga68 DOTATOC, Cu64 DOTATATE) has both sensitivity and specificity over 90 percent for NETs (van de Berg et al., PMID 29025892). Thus, if you have uptake in, for example, the liver, a mesente...
How would you treat gray zone lymphoma which initially achieved a CR after 2 cycles of DA-R-EPOCH, but end-of-treatment PET demonstrates progression with new sites of biopsy-proven disease?
While admittedly the (non randomized) data comes from HL, would consider pembro-GDP vs BV/nivo with the plan to go to auto.
How does the presence of concurrent infections or wound issues affect your choice and timing of induction in patients with AML or MDS with excess blasts?
Many patients are diagnosed with AML or MDS with excess blasts after presenting with acute infections. In these circumstances, early recognition and initiation of broad spectrum antibiotics to prevent sepsis is essential. We typically delay induction chemotherapy until the infection is under control...
Would you offer anti-HER2 therapy to a patient found to have heterogenous HER2+ residual disease after original treatment for TNBC using the KEYNOTE-522 regimen?
This is complicated and there isn't a data driven right/wrong answer for this type of situation that I am aware of. Neoadjuvant treatment can cause shifts in biomarker results in residual tumor tissue compared to the pre-treatment specimen. KY-522 didn't do re-testing of residual tumor. I am not rou...