Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How do you manage chronic radiation laryngeal edema for patients treated with RT for a larynx primary in the past?
I agree with @Dr. First Last's response above. I think it is important to differentiate between laryngeal edema resulting from RT and persisting as a sub-acute toxicity, as opposed to a patient who was treated in the past for larynx cancer and then develops laryngeal edema unexpectedly. In the forme...
Does anyone have experience obtaining sunvozertinib in the second-line setting for patients with EGFR exon 20 insertion mutations?
I have not. Though FDA-approved for months, the drug has not been available for dispensation. Dizal has not had a US presence and has not yet established a distribution partnership. Currently available in China - hoping for access in the US any day now.
How do you approach management of a patient with mast cell leukemia?
Mast cell leukemia (MCL) is a rare and aggressive subtype of systemic mastocytosis defined by ≥20% mast cells in the bone marrow aspirate. A recent multicenter analysis of 92 patients with MCL had a median overall survival (OS) of 1.6 years. Midostaurin was the most common first-line therapy (45% of...
How do you approach management of a patient with mast cell leukemia?
Mast cell leukemia (MCL) is a rare and aggressive subtype of systemic mastocytosis defined by ≥20% mast cells in the bone marrow aspirate. A recent multicenter analysis of 92 patients with MCL had a median overall survival (OS) of 1.6 years. Midostaurin was the most common first-line therapy (45% of...
How exactly would you utilize ADT via leuprolide or bicalutamide with salvage RT post prostatectomy with PSA >0.5?
The dilemma on the need for hormonal therapy in the salvage radiation setting after radical prostatectomy is a major one in current clinical practice, driven by the modest survival benefits seen in the RTOG 9601 trial with 2 years of bicalutamide (Shipley et al., PMID 28146658), but also follow up s...
What is your preferred treatment for arthralgias from AIs?
I usually reassure patients that this is common, and can improve on its own. Because everyone is different i give them options. Duloxetine has the advantage of improving arthralgias, hot flashes and mood. However, a lot of patients are opposed to taking more medication. Acupuncture is effective, and...
In an early stage breast cancer post neoadjuvant chemotherapy, do you repeat ER/PR and HER2 status on the surgical specimen if there is residual disease?
It can be more nuanced than always repeating all the receptors. If there is residual disease after NAC, and the cancer is grade 3, I do feel it is worthwhile to at least repeat HER2. After all, we have good options for reducing the risk of recurrent HER2+ disease in the residual disease after NAC se...
How do the ALTTO trial findings influence your choice of adjuvant endocrine therapy (AI with or without ovarian function suppression versus SERM-based therapy) for patients with HR+/HER2+ early breast cancer?
The major takeaway is that endocrine therapy works for HER2+ breast cancer, although the magnitude of the benefit may not be as large as for ER+/HER2- BC. Thus, OFS will contribute to efficacy in a way similar to that of the TEXT/SOFT trial. Because of the higher toxicity associated with OFS, the ab...
What are your top takeaways in Classical Hematology from ASH 2025?
My top 3 takeaways in classical hematology:1) ITP - much controversy at the education program session about the draft 2025 guidelines, where TPO mimetic + steroids is going to be recommended in the front line. There does not appear to be compelling new data that supports the revision of this guideli...
What are your top takeaways in Classical Hematology from ASH 2025?
My top 3 takeaways in classical hematology:1) ITP - much controversy at the education program session about the draft 2025 guidelines, where TPO mimetic + steroids is going to be recommended in the front line. There does not appear to be compelling new data that supports the revision of this guideli...