Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
What is your simulation setup and dose fractionation for DLBCL of the hand with Deauville 4 residual disease following R-CHOP?
This is a difficult question which I will break into 2 parts: 1) Rx of primary refractory (i.e. chemotherapy resistant) localized DLBCL and 2) special considerations for a hand site. I presume the recurrent/persistent disease is still localized.Treatment of primary refractory DLBCL is a very difficu...
Would you continue ruxolitinib in combination with HMA plus venetoclax in myelofibrosis at the time of transformation to AML?
That is a good question. It would be difficult to give these three agents together as cytopenias would be very difficult to manage. In addition, it’s worth mentioning there are no data for this triplet and these drugs are not approved to be used together. That being said, there are some scenarios we...
Will you use or have you been using the IPSS-M as the primary way to risk-stratify patients with MDS to determine use of hypomethylating agents?
For the last 10 years, the IPSS-R has been the gold standard for risk stratification of patients with MDS. It is used by the NCCN guidelines to split patients into lower or higher risk groups, each with its own distinct treatment recommendations. The IPSS-R has been used to select patients for clini...
Would you consider trastuzumab deruxtecan for a patient with metastatic HER2+ colorectal cancer even if the cancer is RAS mutated?
The best available evidence for the role of trastuzumab deruxtecan (T-DXd) in HER2 positive (IHC 3+ or IHC2+/FISH+) colorectal cancer is the DESTINY-CRC01 study (cohort A) which showed a response rate of 45.3%, median progression-free survival of 4.1 months in patients who had >=2 lines of treatment...
How would you treat a bladder cancer with rectal invasion with radiation?
In general, it may be difficult to achieve durable control with chemoRT alone for such a locally advanced T4 cancer such as this, and the patient may be better served with neoadjuvant chemo, restaging, and cystectomy, if this is feasible. If he is not a candidate/refuses cystectomy, would treat the ...
How do you manage refractory hyponatremia in patients on active therapy in small cell lung cancer?
The classic teaching is that if this is a paraneoplastic SIADH then treat the underlying cancer. If hyponatremia is worsening despite treatment, it might herald progression. I have used tolvaptan in the past as bridge but without effective treatment, this is likely not going to be very effective. Of...
Would you prefer nivolumab/ipilimumab combination over single agent pembrolizumab for a metachronous low volume MSI-H, metastatic colon cancer, with KRAS mutation?
To date, I don't think there are any single negative or positive predictive markers of response to immunotherapy in dMMR/MSI-High.The ones identified retrospectively on subset analyses include KRAS as you mentioned Other studies with BRAF, Or liver metastatic disease Elderly However, my take/experi...
How do you initially treat patients with cN3 cM0 esophageal cancer?
This is an extremely heterogenous group and requires expert multidisciplinary review to generate an individualized plan. In fact, we discussed several patients with N3 disease -- very extensive but technically locoregional lymphadenopathy -- at our Disease Management Team meeting yesterday morning.O...
For a patient requiring adjuvant endocrine therapy for localized breast cancer, would you use fulvestrant if they were intolerant to both aromatase inhibitor and tamoxifen?
I think you may run into coverage issues since fulvestrant is not approved for the treatment of early breast cancer. For patients who don't tolerate AI or tamoxifen, I normally try Fareston (toremifene). I have a small handful of patients in my panel that have tolerated that when they haven't tolera...
Would you consider trastuzumab deruxtecan as next line of therapy for patients with ERBB2 mutation positive, stage IIIB NSCLC, who progress within 6 months of chemo- radiation?
Yes, I would consider trastuzumab deruxtecan as the next line of therapy for patients with ERBB2 mutation-positive, stage IIIB NSCLC, who progress within 6 months of chemo-radiation. We typically use recurrence within one year as the time frame between completion of chemo-radiation and recurrence fo...