Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Is cross reactivity low enough to try cisplatin as an alternative for patients who experience hypersensitivity reaction to carboplatin?
A couple of preparatory comments. First, there is a reasonable review recently published about platinum sensitivity and management questions related to this (Makrilia et al., PMID 20886011). The second comment is that platinum sensitivity reactions can be quite severe, and are relatively rare with <...
How would you manage a patient with epithelioid hemangioendothelioma?
This is typically an indolent tumor, often with multi organ system involvement. Starting point mostly is close observation at 3 mo intervals to get a feel for the pace of growth, and extend intervals as appropriate. For bulky liver disease, one could consider liver directed therapies (ablation/embol...
How would you approach an early stage II unfavorable Hodgkins lymphoma following 6 cycles ABVD with persistent Deauville 5 with negative biopsy?
This is an active disease and should be treated accordingly. I would not wait. RT is certainly option number one now, but the patient has a considerable risk for recurrence even after RT, since he/she has Hodgkin‘s that is not responding adequately to treatment. Continuing with ABVD in a patient who...
When do you refer patients for germline testing when somatic tumor testing is negative for actionable mutations?
Somatic (tumor-only) testing should not be used to conclusively rule in or rule out the presence of a germline pathogenic/likely pathogenic alteration. While most germline sequence alterations (point mutations, small insertions/deletions) will be detected on tumor-only testing, this may miss chromos...
How would you manage a premenopausal woman with DCIS who has a contraindication to tamoxifen?
Given the modest benefits of adjuvant and/or risk reduction endocrine therapy in patients with ER+ DCIS, in terms of reducing the risk of an ipsilateral in-breast recurrence following surgery and radiation and reducing the risk of a contralateral estrogen receptor-positive breast cancer, and the abs...
Are there instances where you would offer erdafitinib instead of avelumab for maintenance therapy for FGFR3 mutated metastatic bladder cancer after stable disease on cisplatin/gemcitabine?
The short answer is 'no'. There are no data for supporting FGFR inhibition in a maintenance first-line setting for those with stable or responding disease on platinum-based chemotherapy and FGFR2/3 activating alterations. There are contrasting data suggesting that the activity of PD1/L1 inhibitors m...
For a patient with PSMA+ mCRPC but relatively low SUV values, does that influence your decision to use 177Lu-PSMA or discussion with patient regarding potential benefit?
In general, the use of PSMA-lutetium is primarily utilized in patients with advanced metastatic castration resistant prostate cancer which has been heavily pre-treated with at least one novel anti-androgen (and often several) and one or two taxane based therapies. No prospective trial has addressed ...
Do you recommend IVIg and/or cytoreduction for patients with IgM MGUS with reciprocal depression in IgG and recurrent infections?
Treating MGUS due to immune suppression is not a common practice. If IgG level is severely depressed below 200 mg/dl with recurrent bacterial infection, I would administer IVIG.
Is there a role for repeat CAR-T with a potentially different product in relapsed and refractory multiple myeloma?
Unfortunately, no great data yet, largely case series and retrospective observations. Our group presented data at the 2022 IMS meeting (Reyes et al., "Salvage Therapies and Clinical Outcomes After Relapse Following BCMA CAR-T in Patients with RRMM") showing a 75% ORR and median duration of response ...
If you treat a patient with high-risk smoldering myeloma on trial and they develop biochemical progression by M-spike, but still no CRAB-SLiM criteria, what would you do next?
My personal preference is to not treat smoldering myeloma.One of the reasons for this is you fall into this very conundrum.The decision to treat was made while the patient was asymptomatic and without end-organ damage. The patient is now in the exact same scenario, so why should the decision-making ...