Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
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...
In a patient with unresectable, multifocal recurrent cutaneous squamous cell carcinoma and underlying T-cell large granular lymphocytic leukemia with baseline moderate pancytopenia, is anti-PD-1 therapy (e.g., cemiplimab) an appropriate and safe treatment option?
This is a complicated question! First, be sure of the diagnosis. The differential diagnosis is quite long. If it is something else that may or may not influence your decision. Second, if we agree that the lesions are not resectable, might they be treated with radiation therapy? This will not give th...
Could patients with smIPI >1 and poor tolerability to R-CHOP be offered ISRT after 3 cycles of R-CHOP if interim PET showed 5-PS 1-3 response?
The revised NCCN guidelines largely reflect data from studies demonstrating excellent outcomes with four cycles of R-CHOP in patients with low-risk diffuse large B-cell lymphoma (DLBCL), including FLYER, LYSA/GOELAMS, SWOG S1001, and the most recent trial, LNH2009-1B. Although each of these trials e...
Could patients with smIPI >1 and poor tolerability to R-CHOP be offered ISRT after 3 cycles of R-CHOP if interim PET showed 5-PS 1-3 response?
The revised NCCN guidelines largely reflect data from studies demonstrating excellent outcomes with four cycles of R-CHOP in patients with low-risk diffuse large B-cell lymphoma (DLBCL), including FLYER, LYSA/GOELAMS, SWOG S1001, and the most recent trial, LNH2009-1B. Although each of these trials e...
For a patient with intracranial mets for ES-SCLC who undergoes resection, do you routinely offer post-op SRS to the cavity, or do you proceed with WBRT?
While Whole Brain Radiation Therapy (WBRT) has been the standard, stereotactic radiosurgery (SRS) to the surgical cavity is increasingly being used to minimize neurocognitive decline. However, the issue is especially more nuanced for an ES-SCLC (we don't know whether the primary has been controlled ...
What is the utility of a hypercoagulability workup in recurrent cryptogenic stroke, and what specific tests would you recommend?
Ambulatory monitoring for AFib is probably more helpful than such a thorough clotting workup.
If using the triplet AMPLIFY regimen with ven/acala/obin upfront, what do you then plan to use in 2nd line treatment of CLL?
For patients who achieve a favorable response that lasts >1 year (or so, this is a ballpark estimate that may shift with more data), I would be very comfortable re-treating with a covalent BTKi (preferably after screening for BTK resistance mutations by NGS where available - with note of caution tha...
If using the triplet AMPLIFY regimen with ven/acala/obin upfront, what do you then plan to use in 2nd line treatment of CLL?
For patients who achieve a favorable response that lasts >1 year (or so, this is a ballpark estimate that may shift with more data), I would be very comfortable re-treating with a covalent BTKi (preferably after screening for BTK resistance mutations by NGS where available - with note of caution tha...
Does postpartum status impact your choice of chemotherapy regimen for young women with a HR+/HER2- invasive ductal carcinoma with 1-3 positive lymph nodes?
No, the postpartum state would not affect my choice of adjuvant chemotherapy in a node-positive patient with HR+/HER2- breast cancer. Would submit tissue for Oncotype analysis to determine if the regimen should include an anthracycline (for Oncotype >30); if not, would favor TC x6 with concurrent ov...
In patients with T1 anal squamous cell cancer status post local excision with a close margin, would you recommend close observation or adjuvant concurrent chemoradiation?
I would solicit the opinions of my colorectal surgery and GI colleagues to see if re-resection (with TAMIS, for example) is possible. If it is not, I would likely observe. If the margin was positive and not just close, I would do traditional chemoradiation.