Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How would you manage relapsed DLBCL in a patient who received second line CD19 CART treatment?
With commercial CD19 CAR-T therapy moving into earlier lines of therapy, post-CAR-T relapses are now more common. There are still many options depending on what first-line/bridging therapy was given, CD19/20/30 expression, and patient preferences. I always get a biopsy if feasible to confirm relapse...
How would you manage relapsed DLBCL in a patient who received second line CD19 CART treatment?
With commercial CD19 CAR-T therapy moving into earlier lines of therapy, post-CAR-T relapses are now more common. There are still many options depending on what first-line/bridging therapy was given, CD19/20/30 expression, and patient preferences. I always get a biopsy if feasible to confirm relapse...
In what cases of T3N0 glottic SCC, would you omit chemotherapy and offer radiation alone?
The question seems to stem from a presentation of a patient that would have historically been stage 2, but more recent editions of AJCC and more refined imaging have upstaged the patient to stage 3 by calling minimal paraglottic extension on an MRI. This is similar to a previous question where a pat...
When would you consider initial induction chemotherapy (e.g. FOLFOX) followed by neoadjuvant chemoradiation, over neoadjuvant chemoradiation alone, in patients with locally advanced rectal cancer?
At MSKCC, we now routinely recommend induction chemotherapy (8 cycles of FOLFOX) to any rectal cancer patient who requires preoperative chemoRT. Initially, we adopted this approach for patients with particularly bulky or node-positive disease (as per @Dr. First Last's answer above) but now do it for...
Do you still recommend protons for grade 2 and grade 3 glioma, following the Soprano study results showing a survival detriment?
I should start by saying that I generally do not recommend proton therapy for grade 2-3 gliomas in adults unless there is a clear and specific indication. Modern photon techniques such as VMAT are highly conformal, efficient, and safe, and they form the backbone of the evidence base that guides our ...
Based on TAILORx, what will be your approach to a pre-menopausal woman with a recurrence score 16-25?
In TAILORx, women with intermediate recurrence scores (11-25) did not benefit from chemotherapy. However, an exploratory analysis suggested some chemotherapy benefit for women age less than 50 (compared to older than 50) with recurrence scores of 16 to 25. Therefore, many would suggest that premenop...
How have the results of the SUNMO trial with mosunetuzumab/polatuzumab vedotin impacted your treatment choices for transplant ineligible relapsed/refractory DLBCL?
The SUNMO trial results have provided another option for patients with relapsed and/or refractory disease who aren't fit enough for more intensive therapy, whether it be salvage + ASCT for relapsed or CAR-T/bispecific + CIT for those with refractory disease. As well, the regimen is likely to have le...
How have the results of the SUNMO trial with mosunetuzumab/polatuzumab vedotin impacted your treatment choices for transplant ineligible relapsed/refractory DLBCL?
The SUNMO trial results have provided another option for patients with relapsed and/or refractory disease who aren't fit enough for more intensive therapy, whether it be salvage + ASCT for relapsed or CAR-T/bispecific + CIT for those with refractory disease. As well, the regimen is likely to have le...
In an adult patient with asymptomatic, isolated neutropenia in whom you suspect a Duffy null phenotype, at what ANC or in what situations would you do a bone marrow to look for other etiologies of neutropenia?
What a great question! Happy to answer. As you know, as many as 60% of individuals who have the Duffy null phenotype will have an ANC that is lower than the lower limit of normal in many labs BUT as you also know, the total body (in circulation + in tissues) neutrophil count in such individuals is n...
In an adult patient with asymptomatic, isolated neutropenia in whom you suspect a Duffy null phenotype, at what ANC or in what situations would you do a bone marrow to look for other etiologies of neutropenia?
What a great question! Happy to answer. As you know, as many as 60% of individuals who have the Duffy null phenotype will have an ANC that is lower than the lower limit of normal in many labs BUT as you also know, the total body (in circulation + in tissues) neutrophil count in such individuals is n...