Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Do you offer adjuvant therapy for localized medullary carcinoma of the ascending colon that is MSI-H?
Medullary carcinoma of the colon is a rare type of colon cancer with unique clinical and molecular features. Despite its high-grade histology, its prognosis is generally better than adenocarcinoma. They tend to be locally advanced and rarely metastasize. They are usually MSI-H with a high number of ...
Would you recommend discontinuing testosterone replacement in a male patient in his 60s with newly diagnosed favorable intermediate-risk prostate cancer who is declining surgery and will receive definitive radiation?
Historically, we (as a field) have viewed TRT as the opposite of ADT and therefore inherently problematic. I am not convinced this is logical. ADT has RCT evidence to support it, whereas withdrawing TRT has not been as cleanly studied. Let's say we stop TRT, and this drops their testosterone to 150 ...
How do you manage refractory myelofibrosis with thrombocytopenia, significant leukocytosis (>150), and ASXL1 mutation?
The answer to this question requires, first, that like any patient with a malignancy, this patient must be staged according to the clinical and laboratory data that define the clonal tumor burden of the disease in question, as well as its extent clinically. In the spirit of full transparency, my ans...
How do you manage refractory myelofibrosis with thrombocytopenia, significant leukocytosis (>150), and ASXL1 mutation?
The answer to this question requires, first, that like any patient with a malignancy, this patient must be staged according to the clinical and laboratory data that define the clonal tumor burden of the disease in question, as well as its extent clinically. In the spirit of full transparency, my ans...
In a patient with an EGFR exon 20 insertion mutation with stage IIIA lung adenocarcinoma, is there any experience using amivantamab + carboplatin + pemetrexed in a neoadjuvant fashion?
No. What is interesting is the use of not a chemoimmunotherapy neoadjuvant approach vs upfront surgery, since more likely than not, the EGFR exon 20 mutation offsets ICI efficacy.
Do you offer enasidenib with azacitadine in AML with an IDH2 mutation for patients ineligible for intensive induction chemotherapy?
I typically do not give enasidenib with azacitidine upfront for patients with AML with IDH2 mutation and ineligible for intensive induction chemotherapy. Based on the results of the VIALE-A study (DiNardo et al, NEJM 2020), I usually give venetoclax with azacitidine to those patients. In addition to...
Do you offer enasidenib with azacitadine in AML with an IDH2 mutation for patients ineligible for intensive induction chemotherapy?
I typically do not give enasidenib with azacitidine upfront for patients with AML with IDH2 mutation and ineligible for intensive induction chemotherapy. Based on the results of the VIALE-A study (DiNardo et al, NEJM 2020), I usually give venetoclax with azacitidine to those patients. In addition to...
Do you recommend adjuvant chemotherapy to a low risk T3N0 stage II colon cancer if there was bowel perforation upstream from the tumor, with mucosa underlying tumor itself being intact?
The upstream perforation is likely from another cause like inflammatory bowel disease, I am assuming. In this situation, I would offer chemo regardless of the upstream perforation. I would consider if they are eligible for a clinical trial that is incorporating ctDNA to help decide. But my understan...
What clinical or logistical factors influence your choice of anti-CD38 antibody in first-line treatment of multiple myeloma?
I generally use daratumumab, because subcutaneous is more convenient for patients, and we go to once-a-month dosing much quicker with daratumumab compared to isatuximab. Once isatuximab subcutaneous is available, this advantage of daratumumab may be lost, but given comfort and familiarity with darat...
What clinical or logistical factors influence your choice of anti-CD38 antibody in first-line treatment of multiple myeloma?
I generally use daratumumab, because subcutaneous is more convenient for patients, and we go to once-a-month dosing much quicker with daratumumab compared to isatuximab. Once isatuximab subcutaneous is available, this advantage of daratumumab may be lost, but given comfort and familiarity with darat...