Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
What high risk features for stage IB NSCLC would lead you to consider adjuvant chemotherapy?
Short answer is "no", I would not change practice based on the recently presented (ASCO) a non-randomized analysis of the potential benefits of adjuvant chemotherapy for patients with stage I NSCLC in Japan (Tsutani, et al. JCO 37(15S):457s, 2019; abst 8500). Many of these patients received UFT rath...
Do you continue to check tryptase levels in your patients with idiopathic anaphylaxis despite normal levels >5 on repeated checks?
Baseline serum tryptase levels have been reported to be quite stable in the vast majority of patients, but can vary more in people with HaT or mastocytosis. With a bST <8 ng/ml, there is no obvious reason to continue to check it. However, even with normal bST, the Practice Parameters recommend furth...
How do you handle hypogammaglobulinemia detected in patients prior to maintenance rituximab infusion?
That is a good question. Adding on to Dr. @Dr. First Last's response, rituximab has been shown to cause hypogammaglobulinemia that can persist or worsen with ongoing therapy. In a study published by Barmettler and colleagues, 133 patients out of a cohort of 8633 patients had serum IgG levels checked...
How do you handle hypogammaglobulinemia detected in patients prior to maintenance rituximab infusion?
That is a good question. Adding on to Dr. @Dr. First Last's response, rituximab has been shown to cause hypogammaglobulinemia that can persist or worsen with ongoing therapy. In a study published by Barmettler and colleagues, 133 patients out of a cohort of 8633 patients had serum IgG levels checked...
Do you still recommend consolidative allogeneic stem cell transplants for patients with Richter transformation in CR after frontline treatment in the modern era of therapies?
The optimal treatment of diffuse large B-cell lymphoma (DLBCL) emerging in the context of underlying chronic lymphocytic leukemia (CLL)/small lymphocytic lymphoma (SLL) (e.g. Richter’s syndrome) is an area of ongoing debate. For initial treatment, I typically administer standard DLBCL chemoimmunothe...
In light of the NSABP B-51 data presented at SABCS, will you defer RNI in all patients with negative nodes after chemotherapy?
Results of the NSABP B-51 trial were presented at the 2023 San Antonio Breast Cancer Symposium (Mamounas et al., abstract GS-02-07). This trial was designed to test the value of postoperative radiation therapy in patients who presented with clinical T1-3N1 tumors with biopsy-proven axillary node inv...
Is there evidence supporting the adjuvant use of neratinib in patients with high-risk, hormone receptor–positive, HER2-negative breast cancer that harbors an activating HER2 mutation?
The data supporting use of neratinib for patients whose breast cancers have activating HER2 mutations is in the metastatic setting (https://www.ncbi.nlm.nih.gov/pubmed/37597578). Neratinib use in the adjuvant setting for breast cancer requires that there be HER2 amplification by IHC or FISH.
With multiple PARPi + ARSI combinations now approved, how are you selecting which combination to use for a patient with BRCA mutated mCRPC?
Updated answer: I do not feel that the data is so much different that I always prioritize saving abiraterone for mCRPC in being able to specifically choose the abi/olaparib combination. I still focus on making the best choice in the mHSPC setting whether that is using ADT/abiraterone or direct AR an...
What adjuvant therapy would you offer for a cisplatin-eligible patient with upper tract urothelial carcinoma and Lynch Syndrome?
Good question and discussed it with Dr. @Dr. First Last. We have seen data from the POUT phase 3 trial (Birtle et al., PMID 32145825) showing significant DFS benefit with adjuvant Gem/Cis vs observation after radical surgery (due to study closure the trial was not powered to show OS benefit) in pati...
For a patient with metastatic colon cancer which is MSI-H/dMMR and BRAF V600E+, what would be your preferred first line treatment?
In line with current NCCN guidelines, I would treat all MSI-H patients, regardless of their BRAF status, with immune checkpoint therapy in first-line unless there were clear contraindications. BREAKWATER excluded MSI-H patients, so this data should not be extrapolated to MSI-H/BRAF V600E mutated pat...