Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Do you offer fertility preservation to patients prior to CAR-T therapy?
There is no evidence yet about the impact of CAR-T itself on fertility, and this will be difficult to study in isolation in this population. Many CAR-T patients have been heavily pre-treated, so semen cryopreservation and oocyte harvesting may not be successful; but if feasible they should be attemp...
How do you decide the right time to transition to hospice?
Talking about hospice is one of the hardest jobs we have. It's hard because we don't like doing it, because we often don't know how to do it well, and because we angst about doing it too early or too late. It's an important thing to think about. I actually think perhaps the most important factor in ...
How would you approach a patient with a recent MI s/p DES who is being considered for neoadjuvant chemotherapy for TNBC?
This is mostly opinion as there is not data specific to this situation. First, I would coordinate closely with the cardiologist, preferably someone with knowledge of cardio-oncology. Presumably the patient is already on cardioprotective medications, such as beta blocker and ACE inhibitor, but if not...
How would you approach maintenance therapy following chemo-immunotherapy for extensive-stage small cell lung cancer per the IMPower133 trial if there is a mixed response post-treatment but clearly some clinical benefit?
The definition of clinical benefit remains a very subjective one. We presume that the patient has had an overall good response to the combination of chemotherapy and immunotherapy, and has undergone restaging imaging during the immunotherapy alone maintenance stage. The above question would suggest ...
What factors influence your decision regarding whether to administer a dose-dense chemotherapy regimen in the adjuvant setting to patients with hormone-receptor postive disease?
Many of the studies included in the analyses treated ER+ cases that we would call lower risk using modern genomic testing with adjuvant chemotherapy. So the observed effect of chemotherapy on recurrence and OS in ER+ disease can vary from study to study, depending on the numbers of low vs high risk ...
Are maintenance therapies for ovarian cancer being held at your institution due to COVID-19?
Patient safety and health care worker safety are of the upmost importance for us. We are doing telehealth visits and able to deliver oral drugs to patient's homes. For infusion visits, those are being decided on a case by case basis, depending on the patient and their disease status.
Would you withhold immunotherapy for ES-SCLC during the COVID-19 pandemic?
Risks of COVID-19 infection and severe pneumonia seem to be higher in our patients with lung cancer. This is fairly early data and some of the patients included in those analyses were not receiving any active therapy. This suggests that at least some of the risk is simply frequent visits to the canc...
How would you manage a patient with a solitary plasmacytoma with a partial response to RT?
A solitary osseous plasmacytoma can be higher or lower risk than an extra medullary plasmacytoma; for instance, a tonsillar plasmacytoma is different than one in lung parenchyma. The largest study I know about evaluating solitary plasmacytoma of the bone involved 206 patients without evidence of mye...
Should our selection for neoadjuvant chemotherapy in ovarian cancer patients change in light of COVID-19?
I see this as a two-pronged question where the response may vary based on the specific clinical situation, circumstances of the hospital, and status of the epidemic locally and regionally, along with available resources associated with the rapidly evolving COVID-19 pandemic. There is no question pri...
Would you recommend anticoagulation prophylaxis for a pediatric patient admitted with COVID-19?
COVID-19 disease in children seems to be less severe than adults based on the current literature and our personal experience at Children's Hospitals. Among adults, the coagulopathy is beginning to be described with elevated inflammatory markers and other markers of coagulation activation, including ...