Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How do you manage grade 3 enterocolitis from 5FU mitomycin and pelvic radiotherapy?
With infection ruled out and CT showing diffuse enterocolitis extending far beyond the bowel-sparing IMRT radiotherapy field, presumably, it is due to the 5FU/mitomycin. In the few cases I have had, it generally heals 2-3 weeks after counts nadir. Besides supportive care (Imodium, Lomotil, Gas-X, ti...
How would you approach cytopenias 5 weeks after initial dosing in a young patient with MDS treated with Azacitadine as a bridge to transplant?
Bridging with HMA to transplant in MDS patients is a common practice although it did not show improved outcomes. You will definitely have to r/o other potential causes of pancytopenia (i.e., infections, etc). I would repeat a BM A/Bx to make sure that blasts are not increasing (< 20% and preferably ...
Do you recommend adjuvant chemotherapy in a patient with node positive gastric adenocarcinoma with mixed dMMR/MSI histology?
Well, this is certainly a situation where treatment decisions are completely unburdened by data and one could do virtually anything, from observation to immunotherapy plus chemotherapy.A more straightforward version of this scenario is if the patient has a fully resected node-positive dMMR/MSI gastr...
How would you approach second line treatment for prostate adenocarcinoma with diffuse neuroendocrine features?
Men with NEPC (histologic evidence of small cell carcinoma) face a poor prognosis and are typically refractory to all hormonal interventions, and in fact transformed NEPC much more typically evolves after potent AR inhibition than present de novo at diagnosis. Autopsy series and biopsy series sugges...
How do you choose bridging therapy prior to CAR-T leukapheresis?
There is a lack of uniform clarity around terminology here. To avoid confusion, I prefer using "debulking" for treatment that is administered prior to T-cell apheresis, and "bridging" for treatment administered after apheresis to bridge the patient during manufacture to maintain disease control prio...
Do you use GCSF for a patient with MDS with excess blasts and neutropenia?
It really depends on what you are trying to achieve: If the goal is to get the patient to a curative allogeneic transplant, then the answer is no. If the goal is to get an elderly frail patient to break fever and leave the hospital to spend some quality time with family, then the answer is yes!
How do you work up a young patient with increasing ferritin and normal TSAT without infectious, inflammatory, or liver disorders?
This is a tough one. If the ferritin is increasing and the TSAT is normal and there is no evidence of hemochromatosis, the ONLY possible explanation is some underlying morbidity, inflammatory, rheumatologic, malignant, or infectious is present. In pediatrics, HLH (hemophagocytic lymphohistiocytosi...
What is the treatment of choice for mixed phenotype ALL?
These are difficult to treat. The limited available data suggest that an ALL–like regimen followed by HSCT may be recommended. If no response is achieved, you could try a myeloid-like strategy. For T/Myeloid, combining asparaginase with AML therapy (FA + PEG or Capizzi II) could be an option. The sp...
How do you utilize p53 NGS testing in your treatment planning for patients with CLL?
When I approach consideration of treatment, it is clear that TP53 mutation or del(17)(p13) chromosome region on interphase cytogenetics identifies a group of patients at risk for progression after treatment with a venetoclax containing regimen and also to a lesser extent BTKi (ibrutinib/acalabrutini...
Can APLS cause a false positive HIT ELISA?
Yes, that has been reported: Pauzner et al., PMID 19291166.