Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How would you approach adjuvant therapy for large (≥4 cm), node negative, HR+, HER2- breast cancer in an elderly woman with comorbidities including neuropathy?
If multiple co-morbidities are present in an elderly patient with locally advanced HR+/HER2- breast cancer that precludes anthracycline and taxane chemotherapy regimen, then I would consider 2 options: (1) CMF regimen which is active and generally well tolerated (one can also consider upfront dose r...
What is your preferred therapy for MDS/MPN with significant leukocytosis and neutrophilia?
Depends on blast count, cytogenetics, and molecular test results, age of patient, performance status, comorbidities, etc. To bring the white count down can temporarily start with hydroxyurea. would use induction chemo versus HMA +/- venetoclax to achieve at least a partial response. can be a candida...
What is your preferred therapy for MDS/MPN with significant leukocytosis and neutrophilia?
Depends on blast count, cytogenetics, and molecular test results, age of patient, performance status, comorbidities, etc. To bring the white count down can temporarily start with hydroxyurea. would use induction chemo versus HMA +/- venetoclax to achieve at least a partial response. can be a candida...
How would you approach adjusting nivo+AVD therapy for advanced Hodgkin lymphoma if a patient develops treatment limited immunotherapy toxicity?
BV-AVD-related transaminitis is relatively common; however, even with Nivo-AVD, transaminitis is frequently observed, albeit at a lower frequency. Most of these events are self-limited and grade 1-2. Depending on the stage and severity of the event, dose holds can be employed; however, adverse event...
How would you approach adjusting nivo+AVD therapy for advanced Hodgkin lymphoma if a patient develops treatment limited immunotherapy toxicity?
BV-AVD-related transaminitis is relatively common; however, even with Nivo-AVD, transaminitis is frequently observed, albeit at a lower frequency. Most of these events are self-limited and grade 1-2. Depending on the stage and severity of the event, dose holds can be employed; however, adverse event...
What is your approach to adjuvant chemotherapy for a postmenopausal woman with pT1cN0 grade 2 ER+ breast cancer (IDC) and OncoType RS of 25?
Since the Oncotype Dx recurrence score of 25 was the upper cut-off for randomization in the TAILORx trial, and since post-menopausal women with Oncotype Dx of 25 or less did not experience any benefit from chemotherapy, I would lean towards avoiding chemotherapy in this situation. However, I would d...
What is your re-immunization strategy after auto SCT for patients with myeloma on dara/len maintenance?
We do the same vaccination sequence according to BMT/CTN, whether they are on maintenance dara or not. Here is our schedule Post autologous SCT vaccine Interval Date Vaccine Yearly Flu Vaccine 3-month post-transplant Pneumovax 20, Hib, hep A/hep B, polio, TDap, Shingrix 6 months post-transplant Pneu...
What is your re-immunization strategy after auto SCT for patients with myeloma on dara/len maintenance?
We do the same vaccination sequence according to BMT/CTN, whether they are on maintenance dara or not. Here is our schedule Post autologous SCT vaccine Interval Date Vaccine Yearly Flu Vaccine 3-month post-transplant Pneumovax 20, Hib, hep A/hep B, polio, TDap, Shingrix 6 months post-transplant Pneu...
Is it ever appropriate to omit temozolomide in unmethylated glioblastoma?
Perhaps a different perspective on this question would be which unmethylated patients would you be willing to not treat with up-front temozolomide? The genesis of the question and conundrum comes from the modest benefit described in the above-mentioned trials for this subgroup. As Hegi herself descr...
How do you manage oxaliplatin-induced splenomegaly?
Oxaliplatin can lead to sinusoidal obstructive syndrome (SOS), which will result in portal hypertension. Splenomegaly is one of the portal hypertension signs.The SOS is correlated with cumulative oxaliplatin dose, and cumulative dose >1000 mg/m2 is considered a potential threshold (Overman et al., P...