Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Are there strategies to mitigate the risk of developing ILD/pneumonitis while using trastuzumab deruxtecan?
The most important strategy is global awareness of ILD as a potentially serious complication that may initially present with subtle signs. Patients and all care team members must not only be aware but remind others in the patient/family care circle. This needs to be reinforced regularly. The recogni...
For patients who have completed up-front docetaxel for metastatic castration-sensitive prostate cancer, should they proceed to abiraterone before the development of castration resistance?
There is data for upfront triplet therapy currently in high-volume HSPC. The triplet therapy consists of ADT + docetaxel x 6 cycles + either darolutamide or abiraterone. Given that this patient has already completed a course of docetaxel, holding off on adding ARSI therapy until the first signs of P...
How would you work up a patient with cutaneous mastocytosis?
In adults, consider mastocytosis as being systemic until you prove it is not. A single normal or low-elevated tryptase does not eliminate the possibility of systemic mastocytosis. All patients should go to Heme/Onc for consideration of bone marrow biopsy and ideally high-sensitivity PCR to look for ...
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.
What induction regimen would you consider for KMT2A-rearranged AML in a young patient with multiple medical co-morbidities who is ineligible for clinical trials?
Given the mention of medical comorbidities and ineligibility for trials, I am going to assume that the patient cannot be treated with an intensive induction regimen. With this in mind, a lower-intensity approach such as azacitidine + venetoclax would be my recommendation. Survival outcomes in adult ...
What induction regimen would you consider for KMT2A-rearranged AML in a young patient with multiple medical co-morbidities who is ineligible for clinical trials?
Given the mention of medical comorbidities and ineligibility for trials, I am going to assume that the patient cannot be treated with an intensive induction regimen. With this in mind, a lower-intensity approach such as azacitidine + venetoclax would be my recommendation. Survival outcomes in adult ...
Does anyone utilize P2Y12 assays to determine if clopidogrel may be ineffective when used for DAPT?
Yes, I use P2Y12 assays in two distinct settings. Medical management: If a patient on clopidogrel mono/dual therapy has disease progression with ICAD or experiences a recurrent ischemic event, I obtain a P2Y12 assay to assess responsiveness. This helps guide the decision to switch to ticagrelor and ...
Would you consider adjuvant capecitabine for a patient with triple-negative metaplastic carcinoma who has microinvasive residual disease (ypT1miN0) following neoadjuvant therapy?
For a patient with triple-negative metaplastic breast cancer and microinvasive residual disease (ypT1miN0)following neoadjuvant therapy, the decision to use adjuvant capecitabine is nuanced and not definitively addressed in current guidelines or trials. General TNBC with Residual Disease: Multiple...
Should GLP-1 agonists be held during chemotherapy?
I think there are several aspects to this question. First, is there evidence that as a class GLP-1 RAs increase the risk of cancer or worsen prognosis during cancer? I could find nothing to raise concerns about outcomes. One recent report even showed a decreased risk of some cancers with GLP-1 RA co...
What is the preferred approach for an AYA patient with VHR B-ALL with iAMP21 mutation with an isolated early CNS relapse?
For relapsed high-risk disease such as iAMP21, the recommended approach is to achieve remission followed by consolidation with allogeneic stem cell transplantation. However, in cases of isolated CNS relapse, I favor CAR T-cell therapy first to achieve and deepen CNS remission, as it has demonstrated...