Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How do you approach treatment selection among novel bispecific antibodies and ADCs for patients with EGFR+ NSCLC previously treated with 3rd generation EGFR inhibitors?
I will focus the conversation here on metastatic NSCLC with EGFR exon 19 deletion or exon 21 L858R mutation. Patients with EGFR exon 20 insertion mutations are discussed in a separate question.The frontline therapy for our involved patient population is osimertinib single agent (less and less used w...
How do you manage the chemotherapy portion of chemoradiation in a patient with stage IIIB (hydronephrosis) cervical cancer, on hemodialysis?
I will make sure to discuss with the patient's nephrologist to see if there are any special considerations, but in general, it is safe to consider either carboplatin or cisplatin with appropriate dose medications while on hemodialysis. In managing these patients, I have found most nephrologists pref...
For patients with SLE, is there an ANC level for which you would hold or adjust hydroxychloroquine in an asymptomatic patient?
Leukopenia most often as lymphocytopenia, of course, is not unusual in lupus. Total WBC less than 4000 is an ACR classification criteria for the disease as is ALC less than 1500 on two occasions. SLICC disease classification requires ALC less than 1000. Total WBC < 3000 generates SLEDAI points. On t...
Is there any benefit to checking serum viscosity in patients with autoimmune disease and headaches/migraines to see if aspirin or clopidogrel may be beneficial?
The serum viscosity test measures the time required for the serum to flow through a calibrated capillary tube under controlled pressure. Clinically significant elevations in viscosity (≥2.5 centipoise, normal range 1.4 - 1.8 cP) can cause symptoms and are most commonly seen in hyperviscosity syndrom...
What is your preferred frontline treatment for CLL in young patients < 50 years old?
For younger patients, just like older patients with CLL, my preference for frontline treatment is based on genomic characteristics, fitness, and patient preference. I also prefer clinical trials over standard therapy, when available. For those young fit patients with IGHV mutated disease, the option...
What is your preferred frontline treatment for CLL in young patients < 50 years old?
For younger patients, just like older patients with CLL, my preference for frontline treatment is based on genomic characteristics, fitness, and patient preference. I also prefer clinical trials over standard therapy, when available. For those young fit patients with IGHV mutated disease, the option...
When considering cytoreductive nephrectomy in metastatic kidney cancer, in which situations would you consider nephron-sparing approaches such as partial nephrectomy or SBRT?
Nephron-sparing strategies (partial nephrectomy or stereotactic radiation therapy are reserved for patients with limited disease, favorable anatomy, or contraindications to surgery, where the goal is to maximize oncologic control while preserving renal function and minimizing morbidity. Careful mult...
How do you manage the thickened secretions secondary to xerostomia during head and neck radiation?
I find that the management of acute effects of RT for H&N treatment is somewhat of a dark art. What works for one patient may not work for another. The thickened secretions are from acute irritation of the salivary glands and not so much from "xerostomia" during the acute phase of RT. For thickened ...
How would you treat an early-stage dMMR rectal squamous cell carcinoma in an otherwise healthy elderly patient?
With no squamous cells in the actual rectum, I typically treat this as I would anal cancer—definitive chemoradiotherapy, ideally with capecitabine/5-FU-mitomycin (Day 1 only).
How would you approach a T1N1 NSCLC with a small peripheral primary tumor and single hilar node in a patient not fit for concurrent chemo or surgery?
If the patient were not a candidate for surgery or chemotherapy, then I would favor hypofractionated radiotherapy to 60 Gy in 15 fractions to both the primary and the hilar lymph node based on UTSW phase I data. If the patient may be a candidate for immunotherapy, then I would strongly consider enro...