Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How should community oncologists practically counsel patients with aggressive lymphomas on the potential treatment course as they move into 2L/3L therapies?
For those who relapse after first line therapy, treatment recommendations are dependent on the timing of relapse. For those who relapse within 12 months of completing first-line therapy and are fit, I would strongly consider referral to a center with CAR T-cell capabilities. As noted before, 5-year ...
How should community oncologists practically counsel patients with aggressive lymphomas on the potential treatment course as they move into 2L/3L therapies?
For those who relapse after first line therapy, treatment recommendations are dependent on the timing of relapse. For those who relapse within 12 months of completing first-line therapy and are fit, I would strongly consider referral to a center with CAR T-cell capabilities. As noted before, 5-year ...
Which patients with relapsed/refractory NHL are appropriate for pre-CAR-T bridging radiation therapy?
Before answering this important question, I think that we, as Radiation Oncologists, should give serious consideration to moving past the terminology of "bridging radiation therapy" and instead refer to it as "pre-CAR-T infusion radiation therapy." Bridging therapy was initially an apt name; we were...
Which patients with relapsed/refractory NHL are appropriate for pre-CAR-T bridging radiation therapy?
Before answering this important question, I think that we, as Radiation Oncologists, should give serious consideration to moving past the terminology of "bridging radiation therapy" and instead refer to it as "pre-CAR-T infusion radiation therapy." Bridging therapy was initially an apt name; we were...
What is your approach to recurrent metastatic high-grade uterine carcinosarcoma with rhabdomyoblastic differentiation?
Carcinosarcomas (even with rhabdomyoblastic differentiation) are still considered to be derived from endometrial tissue. I would treat it as endometrial cancer and not as uterine or soft tissue sarcoma.
When would you feel comfortable with patients who have a history of hormone-receptor positive breast cancer using hormonal IUDs (e.g. Mirena)?
While we typically recommend removing progesterone-secreting IUDs in patients with ER+ breast cancer, especially while receiving chemotherapy or adjuvant endocrine therapy, there is no data that I am aware of to support this recommendation, and we sometimes administer a systemic progestin (megestrol...
How would you manage a patient with marginal zone lymphoma who progress after treatment on a BKTI?
Was the BTKi the first line of therapy? If so, many options remain: 1) anti-CD20 alone if relatively low volume disease, 2) BR/BO, or 3) Len-rituximab. I guess one could now consider Len-ritux-tafa based on InMIND, but marginal zone enrollment was small and the schedule is not easy.
How would you manage a patient with a recent diagnosis of advanced DLBCL (non-GCB subtype) who has baseline grade 3 neuropathy?
Avoid neurotoxic agents. Substitute pola; avoid vincristine.
How would you manage a frail patient with GCB DLBCL who is unable to complete R-CHOP but has moderate residual disease?
We need a little more information to answer this question. First, what was the stage at diagnosis? Why is the patient frail - is this disease related, or is this a result of therapy? The age of the patient can also assist in making this decision. Also, what is the moderate disease? Can this be inclu...
Would you add immunotherapy to chemotherapy for a patient with metastatic NSCLC, an atypical EGFR mutation, and PD-L1 ≥50% who has progressed on osimertinib?
This is a difficult scenario, and there is no data to guide this. There is good evidence to suggest that patients with the classical mutations do not respond to ICIs regardless of PD-L1 expression. There is one small retrospective analysis that included 7 patients with uncommon mutations (G719X and ...