Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Do you recommend a workup for POEMS and/or amyloidosis for IgM monoclonal gammopathies associated with neuropathy?
While IgM monoclonal disorders, amyloidosis, and POEMS syndrome may all be associated with peripheral neuropathy, they are not often confused with one another. A patient with a peripheral neuropathy can be diagnosed most simply by a serum protein electrophoresis. The presence of a monoclonal IgM spi...
When do you suggest ovarian suppression for fertility preservation in premenopausal women receiving neo/adjuvant chemotherapy?
The benefit of ovarian suppression in young breast cancer patients should be looked into from two different aspects. First, the suppression of the ovary resulting in the hormone receptor-dependent cancer stem cell (minimal residual disease) suppression, and second, the preservation of the fertility ...
How do you work up patients with low level monoclonal lymphocytosis and adenopathy?
In the setting where the blood has a CLL-like clone but does not meet criteria for CLL, I would obtain a lymph node biopsy to confirm the diagnosis of SLL. Although this is most likely to be the case, MBL clones can be seen in the blood concomitantly with other cancers as well.
How do you work up patients with low level monoclonal lymphocytosis and adenopathy?
In the setting where the blood has a CLL-like clone but does not meet criteria for CLL, I would obtain a lymph node biopsy to confirm the diagnosis of SLL. Although this is most likely to be the case, MBL clones can be seen in the blood concomitantly with other cancers as well.
How does the POSEIDON meta-analysis results influence your decision on which patients should receive hormone therapy with post-operative radiotherapy for recurrent prostate cancer?
POSEIDON is another landmark analysis from the MARCAP consortium. It adds to the seminal work performed in localized prostate cancer (Kishan et al., PMID 35051385), which serves as the reference study for the use and duration of ADT with radiotherapy, but now in the post-prostatectomy setting.The st...
What is your approach for testing speech in bilingual patients undergoing an awake craniotomy for glioma resection?
In a bilingual patient, it is important to assess the patient's language function in both languages. This would include pre-operative non-invasive functional mapping as well as intra-operative awake mapping. Areas of language function and connectivity are less discrete than sensory and motor functio...
How do you manage grade 2-3 chemotherapy- induced peripheral neuropathy (CIPN) developing during adjuvant paclitaxel therapy for breast cancer?
In cases with grade 2-3 neuropathy, I consider dose reduction of paclitaxel by at least 20%. I have also used duloxetine (30 mg daily for the 1st week and then 60 mg daily based on the randomized study by Smith et al (JAMA 2013)), with fair amount of success. I have also used gabapentin, although wi...
What dose of radiotherapy do you use for low volume Castleman's disease?
Reports in the literature are varied in terms of radiation dose. For scenarios such as this with low volume disease, it is probably reasonable to consider the lower end of ranges reported by others to be successful, such as 30 Gy. Careful pathology review is important for these cases as well. One mu...
What molecular testing are you ordering in the adjuvant and neoadjuvant setting for GI cancers?
The answer depends on the specific GI cancer and the clinical setting (resectable vs. metastatic). Universal NGS is not recommended for resectable non-metastatic colon cancer. MMR/MSI testing and somatic PI3K pathway alterations (including PIK3CA) are recommended for stage II–III disease. Comprehens...
For patients with early stage resected giant cell lung cancer and other less common histologies, are there any specific considerations for adjuvant therapy?
Giant cell carcinomas/pleomorphic carcinomas/sarcomatoid carcinomas are difficult, and typically aggressive entities. In reviewing the literature, there is precious little data to guide the selection of cytotoxic chemotherapy (most reports are pathology studies, some case reports, and unfortunately,...