Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
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...
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...
What is your standard for monitoring triglyceride level during therapy for ALL, particularly in regards to receiving pegaspargase?
Routine monitoring of triglyceride levels is not considered standard practice during pegaspargase therapy. Although hypertriglyceridemia is a common side effect of asparaginase treatment, it typically has no significant clinical impact on management decisions or future use of asparaginase. The condi...
What is your standard for monitoring triglyceride level during therapy for ALL, particularly in regards to receiving pegaspargase?
Routine monitoring of triglyceride levels is not considered standard practice during pegaspargase therapy. Although hypertriglyceridemia is a common side effect of asparaginase treatment, it typically has no significant clinical impact on management decisions or future use of asparaginase. The condi...
Which regimen would you recommend for a young patient with node-positive, triple-negative breast cancer with significant anthracycline-induced cardiomyopathy?
I would consider the NeoPact regimen, consisting of 6 cycles of docetaxel, carboplatin, and pembrolizumab, which is currently being directly compared to the Keynote-522 regimen in the SCARLET trial. Given some immune-related cardiac risks of pembrolizumab, I would strongly recommend that the patient...