Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
What would be the best treatment approach for bladder cancer patients s/p neoadjuvant therapy and surgical resection who develop oligometastatic recurrence within 1 year that is amenable to resection?
I agree with @Dr. First Last that this is a systemic disease and a "harbinger" for other micrometastasis. Data on metastasectomy is retrospective and of low level of evidence due to selection and confounding factors. I personally would not recommend local therapy with surgery or radiation, but rathe...
Would you clear a patient who completed treatment for breast DCIS to donate her kidney to her husband?
Yes.
Are there any subsets of patients where you would consider first-line dacomitinib for EGFR mutations positive NSCLC?
I continue to favor osimertinib as front line therapy for patients with EGFR mutation positive NSCLC. A retrospective analysis of response and benefit of osimertinib in some less common EGFR mutations was published, including G719X, L861Q, and S768I. The analysis showed clinical benefit with osimert...
How would you approach a patient with metastatic squamous NSCLC that progressed on carbo/paclitaxel/pembro and has a FGFR3 S249C mutation?
It is unclear if erda will have efficacy here in nsclc. If no trial available can consider gem while working on potential off label if patient interested, though there is an ongoing study looking at this, which would be best option.
Would you substitute vinblastine for vincristine in RCHOP?
It’s not a good idea since vinblastine is myelosuppressive, unlike vincristine, and not well studied in NHL.
Would you offer consolidative autologous stem cell transplant in CR1 for high risk diffuse large B-cell lymphoma (DLBCL)?
I would not routinely do so, as data do not support routine auto in CR1 for DLBCL outside of a clinical trial. There have been randomized trials evaluating auto in CR1 in patient populations in higher-risk IPI patients that have yielded mixed results, and collectively should be taken as not supporti...
Would you treat a patient with testicular cancer stage I, pure seminoma on orchiectomy, but with high bHCG (in 1000s) as seminoma or as non-seminoma?
It would depend on what happens with the HCG of 1000 after orchiectomy. If it normalizes, I would proceed with active surveillance. If it persists or plateaus at a high level post orchiectomy, I would treat them the same way I would with a CSIS non seminoma typically BEP X 3. I would also review the...
Would you offer systemic therapy for BCLC Stage C HCC (portal vein invasion) following local therapy with Y90?
BCLC stage C HCC includes patients with advanced diseases with symptoms and/or invasive pattern by vascular invasion or extrahepatic spread. These patients are eligible for palliative treatments including systemic therapy in a standard of care setting or clinical trial.For consideration of systemic ...
For locally recurrent disease after surgical resection of EGFR/ALK positive NSCLC that appears suitable for chemoradiation, would you proceed directly to chemoradiation or consider TKI first?
It depends on a lot of factors—initial stage, whether adjuvant chemo was administered or not, how soon after completion of initial treatment did patient recur, was a complete restaging work up done? How bulky is the recurrence? If patients have limited loco-regional recurrence and did not receive ch...
Would you consider splenectomy for an early stage l/ll primary splenic diffuse large B cell lymphoma followed by R-CHOP?
No reason to remove the spleen in most cases unless it was removed to secure the diagnosis. In this case, I assume the spleen was biopsied already? I would treat as you would a stage I DLBCL (the spleen is nodal tissue), but consider 6 cycles of R-CHOP if possible. If CR by PET at the end of treatme...