Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How do you approach second-line options for relapsed myeloma after front-line quadruplet therapy?
It depends on the patient's case. In the setting of high-risk disease, whether clinically high risk or with HRC would prefer to use CAR-T in the second line. Currently, SoC allows for bispecific use beyond the 4th line, therefore would use triplet such as DPd (APOLLO) or IsaPD (ICARIA) second line f...
How do you approach second-line options for relapsed myeloma after front-line quadruplet therapy?
It depends on the patient's case. In the setting of high-risk disease, whether clinically high risk or with HRC would prefer to use CAR-T in the second line. Currently, SoC allows for bispecific use beyond the 4th line, therefore would use triplet such as DPd (APOLLO) or IsaPD (ICARIA) second line f...
How would you approach adjuvant endocrine therapy after excision of a hormone positive recurrence after mastectomy who finished 5 years of aromatase inhibitor for the same primary tumor in the context of NATALEE and MonarchE trials?
The key question is whether this is an endocrine-sensitive or endocrine-resistant disease. If this recurrence happened after discontinuation of endocrine therapy, then most likely it is because of withdrawing therapy that was effectively suppressing the disease. This is not an uncommon scenario, and...
How do you approach a patient with stage IIA non-small cell lung cancer who received SBRT?
Well, this is a very challenging question that certainly has come up in discussions at times over the years and I could conclude with a very simple answer: No or could offer a more twisted answer arriving at the same response- just for the fun of it, let’s do the latter.So how would we, as a multidi...
Would you offer immunotherapy after chemoradiotherapy for Stage III lung cancer given results of PACIFIC Trial?
In light of the comments by Professor Vansteenkinste comparing the ESMO 2017 plenary session incorporating the PACIFIC study results as a “tsunami” in the footsteps of last year’s ESMO lung cancer “earthquake” presentations, an appropriate title to this question might be- should we let the” floodgat...
How do you decide the dose of aspirin to use in MPN patients?
The standard dose for aspirin in the USA for MPN patients is aspirin 81 mg daily. I sometimes use 81 mg BID for patients with significant CV comorbidities. Some patients with headaches or microcirculatory symptoms may improve symptomatically with BID aspirin. Lastly, patients with erythromelalgia wi...
Is there a role for bevacizimab (IV or IA) for steroid refractory radionecrosis for AVM?
Radiation necrosis (RN) following SRS can occur at variable intervals of time following treatment, usually occurring 9-18 months later. The preferred first line of approach is usually steroids, as done in this case. I usually look at the MRI-Flair images and determine the dose of dexamethasone depen...
Would you offer adjuvant chemotherapy for a pT1c triple negative invasive papillary carcinoma of breast?
I would offer it if the node is positive. For node negative, I would determine it according to the potential risk of relapse and the benefits and risks of systemic therapy.
What volumes do you treat for ISRT for extranodal DLBCL?
It is important to remember that ISRT, for both Hodgkin and non-Hodgkin lymphoma, consists of a set of principles that can be used to design rational radiation fields in the context of modern treatment planning. In general, only sites of original involvement are treated when patients also receive, a...
When utilizing ISRT for Hodgkin lymphoma, what volumetric expansions (ITV and PTV) are appropriate on top of the CTV that includes the original pre-systemic therapy disease?
First, it is important to realize that involved-site radiation therapy (ISRT) for Hodgkin lymphoma is not a formulaic approach to field design. It requires careful evaluation of pre-chemotherapy imaging, fusing these with post-chemotherapy planning CT scans for optimal target delineation, evaluating...