Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How do you manage adjuvant endocrine therapy for pre-menopausal women with locally advanced, weakly positive ER/PR, HER2 negative breast cancer?
Likely very little benefit. Reasonable to try tamoxifen if tolerated.
What would you offer to a patient with musculoskeletal pain from tarlatamab, requiring hospitalization and opioid use?
Bone and muscle pain with tarlatamab can be significant (affecting nearly one-third of patients in clinical trials, I think). A multimodal plan combining opioids with non-opioid analgesics, supportive therapies, and proactive side effect monitoring is often necessary to combat this.The pathway that ...
For patients with a history of pregnancy loss, do you evaluate for PAI-1 polymorphisms as part of a thrombophilia workup?
I do not.The relationship between PAI-1 polymorphisms and thrombosis is complicated, and general guidance suggests against assessing for PAI-1 overexpression as part of a thrombophilia workup. While there is some data to suggest an association between PAI-1 polymorphisms and pregnancy loss, ALIFE2 s...
Would you consider prophylactic anticoagulation for May-Thurner syndrome in pregnancy if prior endovascular intervention has been completed?
In general, I have a very low threshold to initiate prophylactic anticoagulation in pregnancy. For a patient with a history of May-Thurner that has been endovascularly corrected and who has been maintained off of anticoagulation without issue, I would have a risk-benefit discussion about prophylacti...
What is your approach to consolidation for localized small cell bladder cancer after neoadjuvant cisplatin and etoposide?
There is limited data with regard to the best management of these patients. Most data is retrospective and has an inherent bias. That being said, there seems to be a benefit for surgical resection after NAC (Patel et al., 24036236), with RT a consideration if surgery is not an option. In a small ser...
Given the new ASCO guidelines on SNB in early stage breast cancer, how does the omission of SNB in patients aged 50-70 impact your adjuvant radiation recommendations?
If the patient is otherwise a good candidate for APBI (age > 50, pT1 tumor, ER+, HER2 negative, Recurrence score low and intending to take endocrine therapy) that was clinically node negative and ultrasound axilla negative, I feel completely comfortable treating with APBI post lumpectomy with negati...
Will you offer durva-FLOT perioperatively for adenocarcinoma of the esophagus?
Yes, especially distal or GEJ.
Would you offer a third course of palliative radiation after two courses of 8 Gy in 1 fx?
There are rarely definitive answers to questions like these, but I’ll do my best to detail some of my thoughts on how I would approach this situation, since I was asked to fill this request. I would usually have a conversation with a patient about the risks and benefits, and then utilize a shared, i...
How long would you anticoagulate a patient with recurrent VTE who has ongoing risk factors for intracranial bleeding?
In general, my preferred agent outside of the inpatient setting in patients with a risk of intracranial bleeding is LMWH. In the inpatient setting, utilizing a bivalirudin or heparin gtt is most appropriate. I would monitor carefully, including potentially imaging 24 hours after the therapeutic anti...
What factors do you take into account when deciding the length of adjuvant temozolamide in GBM?
The field is evolving from 12 cycles to 6 for IDH-wildtype GBM in recent years, on the basis of some retrospective studies and notably the prospective Spanish study GEINO 14-01 - there does not seem to be much OS benefit, and there are also toxicity concerns (myelosuppression, hypermutation). Extens...