Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
For transplant-ineligible aplastic anemia planned for immunosuppression, how do you approach duration and tapering of cyclosporine and eltrombopag?
One of the most common mistakes in the management of AA is premature tapering of cyclosporine or tacrolimus. If there is a complete remission, and by that I mean normalization of counts, not complete remission as defined in some papers (e.g., ANC 1000, Plts 100,000, Hb 10 as in de Latour et al., PMI...
How do you contextualize the stage 1 results from the PRESERVE-003 trial within the current treatment landscape for patients with squamous NSCLC who have progressed on PDL-1 therapy?
The PRESERVE-003 trial evaluated gotistobart, a novel CTLA-4 antibody, compared to docetaxel in participants with squamous cell NSCLC who had tumor progression on prior platinum-based doublet chemotherapy and immunotherapy. The trial was conducted in 2 stages, and results from the first stage are av...
What is your preferred assay for assessing dabigatran levels?
The only specific assay that would reflect drug levels is the ecarin clotting time with dabigatran as a calibrator. We used to have this assay in our lab, but due to a lack of use, it was discontinued. The standard thrombin time is too sensitive; however, dilute thrombin time has been used. The mass...
Would you ever consider treatment without tissue diagnosis for a gastrointestinal neuroendocrine metastatic tumor based on a positive DOTATATE scan alone?
Tissue would be ideal, but I would treat the above scenario with caveats. The sensitivity and specificity of modern-day DOTA SSTR imaging approaches 90%. The question I would have is whether the patient needs treatment in the first place, based on burden of disease seen? Is disease behaving aggressi...
What guides your choice between prophylactic, intermediate, and full therapeutic dosing of enoxaparin in a woman with APLS and prior fetal loss with no hx of thromboembolic disease?
First, it is essential to confirm that patients meet criteria for obstetric antiphospholipid antibody syndrome (OAPS), based on the 2023 ACR/EULAR classification criteria. This includes persistently positive laboratory criteria (confirmed on repeat testing >12 weeks apart), plus otherwise unexplaine...
What would your approach be for a locally advanced head and neck cancer diagnosed concurrently with a mid-esophageal cancer?
In the handful of similar cases that I have seen, I have worked with medical oncology to tease out a concurrent chemotherapy regimen. What we have often ended up doing is treating the head and neck cancer as normal (to 70 Gy) and the esophagus cancer to a relatively standard dose (usually to 50 Gy t...
Which group of Stage III MSI-H colon cancer patients can be excluded from receiving adjuvant chemotherapy?
10% to 15% of patients with early-stage, and 4% of patients with metastatic colorectal cancer (CRC) test positive for dMMR. In stage II-III colon cancers, MSI-H/dMMR status is predictive of resistance to 5-fluorouracil as monotherapy, (Sargent et al., PMID 20498393) such that the addition of oxalipl...
In mCRPC patients who had an initial response to Pluvicto but progress within 12 months, where do you position PSMA radioligand retreatment relative to other next-line systemic options in your sequencing strategy?
After Lu-PSMA therapy, we may consider taxane chemotherapy, Ra-223, ARPI, or clinical trials in addition to Lu-PSMA retreatment. Retreatment may be more heavily considered in patients with prior deep response to Lu-PSMA, high avidity on a repeat PSMA PET, and/or limited candidacy for other treatment...
How do you manage therapy in an elderly, >80 years of age, patient with triple-negative breast cancer that is not a surgical candidate?
Treatment decisions for these patients can best be made based on geriatric assessment, estimated life expectancy, whether the treatment goal is prolonged survival or palliation, the potential benefits and toxicities of a specific treatment, and the patient’s personal goals for treatment. The number ...
Would you expect a reduced neutrophil count in individuals with a partial duffy null phenotype?
The Duffy null phenotype's impact on neutrophil counts is "all or none". Approximately one-third of patients with the Duffy null phenotype Fy (a-b-) will have a neutrophil count below the usual lower limit of normal. The range of neutrophil counts in individuals with Fy (a+b-) and Fy (a-b+) is exact...