Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Are you offering Lutathera for multiple recurrent meningiomas?
Lutathera is currently only FDA-approved for treating somatostatin receptor-positive gastroenteropancreatic neuroendocrine tumors (GEP-NETs). However, research is ongoing to explore its potential use for meningiomas, as many meningiomas express somatostatin receptors, which could make it a promising...
How do you manage persistent cytopenias after FCR chemotherapy for treatment of CLL?
For persistent cytopenias after FCR, the initial approach would be supportive care. If no recovery after 12 weeks, consideration should be for a bone marrow biopsy to evaluate for aplasia, an autoimmune process like PRCA, or early MDS. The therapy after the bone marrow would be based on the result. ...
How do you manage persistent cytopenias after FCR chemotherapy for treatment of CLL?
For persistent cytopenias after FCR, the initial approach would be supportive care. If no recovery after 12 weeks, consideration should be for a bone marrow biopsy to evaluate for aplasia, an autoimmune process like PRCA, or early MDS. The therapy after the bone marrow would be based on the result. ...
What is your approach to a situation where DILI is suspected secondary to an important medication (e.g., anticoagulation, antibiotics, etc.), but the diagnosis is uncertain and the liver injury is relatively mild?
If the drug suspected to induce liver injury causes symptoms and ALT is >3 times the upper limit of normal (ULN), I would stop the drug and find an alternative. Even if no symptoms are present, I would stop if ALT is >5 times ULN. Any level increase of ALT below the above parameters would still requ...
What is your experience with Pylarify vs. Posluma PSMA PET for prostate cancer and is one preferred over the other?
There is no definitive evidence at this time that one of these imaging agents is clearly superior to the other because there are no comparative data in the same patient group.For Posluma, the potential benefit over Pylarify would be lower bladder excretion allowing for better visualization of the pe...
How do you approach delivery planning in patients with T1 vWD?
For VWD, I recommend that the mode and timing of delivery be obstetric-based (i.e., the presence of VWD has no effect on the decision). If a CSX is needed, I consider an epidural safe if preceded by VWD-specific therapy. I base the duration of VWD-specific therapy on clinical history and 3rd-trimest...
Have you had patients who wish to take ivermectin and/or fenbendazole as adjunct treatments for gynecologic cancers, and if so, how have you handled this?
Since COVID, there are definitely more patients interested in ivermectin and/or fenbendazole, as well as other alternative therapies. I will counsel the patients on the data for standard of care therapy, but also acknowledge that it is also their body, their life, and ultimately their choice what tr...
Is there evidence supporting the use of nab-paclitaxel in place of paclitaxel in the KEYNOTE-522 neoadjuvant regimen for triple-negative breast cancer, in cases of paclitaxel hypersensitivity?
While I am not aware of any evidence on the specific substitution of nab-paclitaxel for paclitaxel in the KEYNOTE-522 regimen, there is certainly data on the efficacy of nab-paclitaxel in the neoadjuvant setting in a variety of breast cancer subtypes, For example, in the ETNA trial (Gianni et al., P...
How should early-stage, well-differentiated neuroendocrine neoplasms of the breast with intermediate proliferative index (Ki-67 approximately 20–30%) be managed in the adjuvant setting?
Primary neuroendocrine cancer of the breast is a rare entity and in 2013, WHO classified the neuroendocrine cancers of the breast (NECB) into three subtypes - well-differentiated NE tumors, poorly differentiated small cell carcinoma of the breast, invasive breast cancer with NE differentiation. By d...
Is obinutuzumab obligatory with AV combination for patients with unmutated IGHV?
Obinutuzumab certainly improves PFS and TTNT but it's important to recall that the OS (in the non-COVID-19 adjusted data) was inferior with AVO in the full cohort. I will certainly discuss adding obinutuzumab for patients with unmutated IgHV with all patients, but will recommend it only for patients...