Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Have you had patients who wish to take ivermectin and/or fenbendazole as adjunct treatments for gynecologic cancers, and if so, how have you handled this?
Since COVID, there are definitely more patients interested in ivermectin and/or fenbendazole, as well as other alternative therapies. I will counsel the patients on the data for standard of care therapy, but also acknowledge that it is also their body, their life, and ultimately their choice what tr...
Is there evidence supporting the use of nab-paclitaxel in place of paclitaxel in the KEYNOTE-522 neoadjuvant regimen for triple-negative breast cancer, in cases of paclitaxel hypersensitivity?
While I am not aware of any evidence on the specific substitution of nab-paclitaxel for paclitaxel in the KEYNOTE-522 regimen, there is certainly data on the efficacy of nab-paclitaxel in the neoadjuvant setting in a variety of breast cancer subtypes, For example, in the ETNA trial (Gianni et al., P...
How should early-stage, well-differentiated neuroendocrine neoplasms of the breast with intermediate proliferative index (Ki-67 approximately 20–30%) be managed in the adjuvant setting?
Primary neuroendocrine cancer of the breast is a rare entity and in 2013, WHO classified the neuroendocrine cancers of the breast (NECB) into three subtypes - well-differentiated NE tumors, poorly differentiated small cell carcinoma of the breast, invasive breast cancer with NE differentiation. By d...
Is obinutuzumab obligatory with AV combination for patients with unmutated IGHV?
Obinutuzumab certainly improves PFS and TTNT but it's important to recall that the OS (in the non-COVID-19 adjusted data) was inferior with AVO in the full cohort. I will certainly discuss adding obinutuzumab for patients with unmutated IgHV with all patients, but will recommend it only for patients...
Is obinutuzumab obligatory with AV combination for patients with unmutated IGHV?
Obinutuzumab certainly improves PFS and TTNT but it's important to recall that the OS (in the non-COVID-19 adjusted data) was inferior with AVO in the full cohort. I will certainly discuss adding obinutuzumab for patients with unmutated IgHV with all patients, but will recommend it only for patients...
In which patients with essential thrombocythemia would you use ropeginterferon alfa-2b?
Currently, the FDA's only indication for Besremi (ropeginterferon) is polycythemia vera (PV). I am not sure why this is since there is ample data on treating essential thrombocytosis (ET) patients with pegylated interferon. So, if still available, my answer covers the use of either. It also covers E...
In which patients with essential thrombocythemia would you use ropeginterferon alfa-2b?
Currently, the FDA's only indication for Besremi (ropeginterferon) is polycythemia vera (PV). I am not sure why this is since there is ample data on treating essential thrombocytosis (ET) patients with pegylated interferon. So, if still available, my answer covers the use of either. It also covers E...
What is your preferred strategy for young adults with ITP complicated by recurrent autoimmune neutropenia?
This is a great question, and I'll say that AIN can be particularly difficult to treat! I'd first ask how low the ANC is and if the patient is presenting with frequent infections/hospitalizations. If not, there may not be a need to treat the AIN (we may just be treating ourselves); oftentimes, there...
In ES-SCLC presenting with extensive brain metastases, how do you time whole brain radiation after the first cycle of chemotherapy has already been delivered?
We typically try to wait as long as possible before we start WBRT. It depends on the burden and symptomatology of intracranial disease as well as the initial response to chemo-immunotherapy. If the brain metastases are asymptomatic and deemed OK to monitor closely (i.e., not likely to cause neurolog...
Which patients with muscle invasive bladder cancer will you treat with adjuvant nivolumab?
I treat patients who fulfill the eligibility criteria of CheckMate 274. Thus, patients must have had radical surgery (R0, with negative surgical margins) within 120 days before randomization, with or without neoadjuvant cisplatin-based chemotherapy. Patients must have had pathological evidence of ur...