Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Do you choose to include or omit growth factor support in the treatment of Hodgkins lymphoma?
I typically do not use "up front" growth factor support unless my patient is frail. If symptomatic neutropenia develops during therapy I will add growth factor support at that time. For the patient with asymptomatic neutropenia I will continue therapy and individualize the decision for the addition ...
How do you approach a patient with high titer ANA and a new diagnosis of ITP, but no other signs or symptoms suggestive of active rheumatologic disease?
I would certainly treat the ITP with hematology involvement if necessary but would continue to monitor for lupus or similar CTDs. I have seen patients present with an ITP-like picture for years before lupus declared itself eventually. It may take years. I would also check a UA for proteinuria. This ...
Would you recommend adjuvant chemotherapy for a patient with subcentimeter pancreatic adenocarcinoma incidentally found during a Whipple resection for high risk IPMN?
Short answer is yes, I do. IPMNs with a foci of invasive carcinoma are at risk for recurrence. The prognosis is generally felt to be more favorable than with conventional PDAC, but that may be due to a higher percentage of them being found at an earlier stage. (E.g. ~25% IPMN-associated carcinomas d...
Would you recommend adjuvant cisplatin/gemcitabine or nivolumab in a patient with muscle invasive bladder CA who proceeded to radical cystectomy first?
This is an excellent question and one we are seeing more and more in clinics these days now that the FDA has approved nivolumab for adjuvant therapy for patients with locally advanced urothelial carcinoma at high risk of recurrence after radical resection. This is based on data from CheckMate 274 wh...
If you are using talquetamab as bridging before BCMA CAR-T therapy, when do you assess for response and/or stop the talquetamab?
I’m not fond of the talq approach based on personal experience, but the data looks quite good. Most patients only get about 2-3 full doses before cells are ready. I aim to get step-up dosing completed and then move to 0.8 mg/kg every 2 weeks. That is generally enough to obtain a durable and deep eno...
Does stopping anagrelide affect fibrosis in patients with ET who develop post-ET myelofibrosis?
Anagrelide is a phosphodiesterase (PDE) III inhibitor, developed initially as a platelet antiaggregant, but was found to have platelet lowering activity at concentrations lower than its platelet antiaggregant activity. Thus, it was consequently marketed to reduce thrombocytosis in MPN patients. It i...
In what situations would you recommend adjuvant radiation therapy for patients with locally advanced and/or recurrent basal cell carcinoma that receive vismodegib followed by surgery?
Adjuvant radiation therapy should be considered for locally advanced basal cell carcinomas when surgical margins are positive, or when there is perineural invasion, particularly in high-risk anatomical locations such as the face. This recommendation is endorsed by both the NCCN and the American Acad...
Does pre-chemotherapy extent of nodal involvement impact your decision to offer adjuvant radiation in cN1, ypN0 triple-negative breast cancer?
There are few data on this subject. The group at the Netherlands Cancer Institute in Amsterdam created what they called the "MARI" approach for such patients (Koolen et al., PMID 28524246). In brief, they performed an axillary ultrasound and marked the largest suspicious node with a radioactive seed...
Would you recommend an allogenic stem cell transplant in an older patient > 50 with Ph negative acute lymphoblastic leukemia who is MRD negative after induction?
In general, I would not routinely recommend allogeneic hematopoietic cell transplantation (HCT) for Ph- acute lymphoblastic leukemia (ALL) that is in MRD-negative remission this early in their treatment. This sort of response demonstrates significant chemosensitivity. Therefore, I would favor contin...
Would you recommend an allogenic stem cell transplant in an older patient > 50 with Ph negative acute lymphoblastic leukemia who is MRD negative after induction?
In general, I would not routinely recommend allogeneic hematopoietic cell transplantation (HCT) for Ph- acute lymphoblastic leukemia (ALL) that is in MRD-negative remission this early in their treatment. This sort of response demonstrates significant chemosensitivity. Therefore, I would favor contin...