Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
What therapy would you recommend for metastatic myxoid liposarcoma in a young patient with anthracycline cardiomyopathy with EF 25% who failed eribulin?
I am going to guess that:1. Patient has doxorubicin cardiomyopathy because she got adjuvant doxorubicin and ifosfamide with initial tumor.2. It was long enough ago that there has been time to develop cardiomyopathy.3. If she was without progression long enough to develop cardiomyopathy you could mak...
Do you modify your neoadjuvant considerations for patients with micropapillary histology and pT2 urothelial carcinoma and no distant neoplastic disease?
No. The prognostic significance of this histology is uncertain (EAU Systematic Review, Veskimae et al., Eur Urol Onc 2019). Prospective well powered studies with overall survival as the primary outcome and which incorporate disease classifiers that are more accurate than histology (e.g. a molecular ...
What cisplatin regimen do you prefer with adjuvant radiation in oropharyngeal SCC that is pT4N2 after surgery and bilateral neck dissection?
Cisplatin 40 mg/m2 weekly.
Would you consider giving ESA for anemia secondary to chronic kidney disease in a patient with follicular lymphoma in remission and on rituximab maintenance?
Yes. The risk of ESA has been re-evaluated and is not considered a risk of NHL. Even with the prior retrospective data, follicular lymphoma is not a curable disease and therefore ESA would not have been contraindicated.
Is there a role for adjuvant therapy, either radiation (+/- chemo), or systemic therapies (immunotherapy, targeted agents or chemotherapy) after resection of anorectal mucosal melanoma?
Anorectal mucosal melanoma has a very poor prognosis because of later diagnosis and its aggressive biology. The 5-year survival figures after local therapy (surgery/RT) is about 25%. Hence, there is a need to offer such patients adjuvant systemic therapy. Chemotherapy alone is minimally effective. T...
What is your preferred treatment for a resected composite hemangioendothelioma of the skin arising from a childhood hemangioma?
Close observation would be most reasonable. Reoperate if there is a recurrence. Does not seem to conform to any specific genetic predisposition syndrome, but testing through a Geneticist can't hurt.
How do you approach the re-challenge with trastuzumab in metastatic HER2+ patients who develop cardiomyopathy on trastuzumab/pertuzumab with subsequent improvement with discontinuation?
First, I send all my patients in this situation to the cardiologist. Second, I will re-start the treatment with close cardiology follow-up. Whether to re-load or not is an open question. I personally do not re-load, but I don’t think is wrong to re-load.
How do you decide whether to obtain dental evaluation to reduce the risk of medication-related osteonecrosis of the jaw prior to initiating non-urgent bone-modifying agent therapy?
I have a practice that I send all patients, even edentulous patients, for a dental screening examination if they have a non-emergent need bone-modifying agents (BMAs). That recommendation comes from osteonecrosis guidelines published in J Clin Oncol 2019. The reason for this recommendation is when s...
Would you consider low dose lenvatinib or dabrafenib/trametinib for rapidly progressive RAI refractory thyroid cancer with BRAF V600E mutation in a patient in whom you are concerned about tolerance of full dose lenvatinib?
I would start with lower doses of Dabrafenib (50 mg BID) and Trametinib (0.5 mg QD) and increase doses as tolerated. I institute Lenvatinib if they fail Dabrafenib and Trametinib. It is not unusual for me to start Lenvatinib at 10 mg daily. But I do not give more 20 mg daily dose.