Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How do you counsel a patient diagnosed with HTLV after an abnormal blood donor screening, especially in light of new data that dolutegravir may reduce uncommon but severe neurological outcomes associated with infection?
We actually do not see many individuals with HTLV disease at present in the US. Having said that, HTLV is a retrovirus, so it is biologically plausible that integrase inhibitors (like dolutegravir) could reduce viral spread in the body. However, the key counseling message is: evidence is still emerg...
How do you counsel a patient diagnosed with HTLV after an abnormal blood donor screening, especially in light of new data that dolutegravir may reduce uncommon but severe neurological outcomes associated with infection?
We actually do not see many individuals with HTLV disease at present in the US. Having said that, HTLV is a retrovirus, so it is biologically plausible that integrase inhibitors (like dolutegravir) could reduce viral spread in the body. However, the key counseling message is: evidence is still emerg...
Do you need renal biopsy before SBRT for RCC suspicious cancer?
Yes. The teaching is usually that ≈ 20% of small renal masses (<4 cm) are benign, and this rate goes down as size increases (Thompson et al., PMID 19286217). Features such as contrast enhancement, tumor location, and sex can help to improve the malignant risk potential of these lesions, but no combi...
Would you recommend adjuvant immunotherapy after platinum-based chemotherapy for patients with in resected NSCLC with HER2 mutations?
The benefit of immunotherapy in HER2 mutant NSCLC is an active topic of debate. I do not typically recommend adjuvant immunotherapy after platinum-based chemotherapy for patients with resected HER2-mutant NSCLC. Tumors with oncogenic drivers, specifically EGFR, ALK, ROS, RET, and HER2, show reduced ...
Do you offer consolidation chemotherapy prior to durvalumab in locally advanced, unresectable NSCLC?
I do not offer consolidation chemotherapy to patients prior to durvalumab in patients with locally advanced, unresectable NSCLC. The PACIFIC trial was a randomized phase III trial that established the role of consolidation durvalumab after definitive chemoradiation for patients with stage III NSCLC....
Are Mammaprint and OncotypeDx as useful in stratifying risk in patients with early stage HR+, HER2 negative lobular carcinomas, as in those with ductal carcinomas?
OncotypDX is not very useful in stratifying patients with early stage HR+ HER 2 negative invasive lobular carcinoma. Several studies (MD Anderson, Penn State) have shown that only 1-2 % of invasive ILC cancers are classified as High risk therefore receiving strong recommendation for chemotherapy. Si...
In early-stage ER‑positive, HER2‑negative breast cancer with germline BRCA1 mutation and high genomic risk, how should the choice between neoadjuvant and adjuvant chemotherapy be approached?
I typically do not use the BRCA1 mutation as the determining factor for a neo-adjuvant or adjuvant chemotherapy approach in patients with hormone receptor-positive, HER2-negative non-metastatic breast cancer. However, if the patient's characteristics and their disease would fit the eligibility crite...
How do you decide between blinatumomab or traditional chemotherapy in combination with TKI for upfront treatment of adult patients with Ph + ALL?
This question is likely inspired by the recent publication of a "chemotherapy-free induction and consolidation first-line treatment" for adults with Ph+ ALL (Foà et al., PMID 33085860; GIMEMA LAL2116). The authors reported relatively high rates of MRD- remissions by bone marrow BCR-ABL1 RT-PCR and i...
How do you decide between blinatumomab or traditional chemotherapy in combination with TKI for upfront treatment of adult patients with Ph + ALL?
This question is likely inspired by the recent publication of a "chemotherapy-free induction and consolidation first-line treatment" for adults with Ph+ ALL (Foà et al., PMID 33085860; GIMEMA LAL2116). The authors reported relatively high rates of MRD- remissions by bone marrow BCR-ABL1 RT-PCR and i...
What is your preferred treatment for non-contiguous Stage IIA Nodular Lymphocyte Predominant Hodgkin's Lymphoma (NLPHL)?
Prognosis of patients with early stage NLP-HL is excellent with any treatment, and multi-institutional studies have shown 5-year survival rates of 98% (Michael S. et al. Stage I-II nodular lymphocyte-predominant Hodgkin lymphoma: a multi-institutional study of adult patients by ILROG. Blood 2020; 13...