Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Can lupus anticoagulant be positive despite a normal aPTT?
aPTT is one of the assays that may be abnormal in the presence of lupus anticoagulant, but not always. Usually, when screening for lupus anticoagulant, there will be a "special" aPTT assay used that is a bit more sensitive to detect lupus anticoagulant. There are several different aPTT-based assays ...
Do you give adjuvant chemotherapy/trastuzumab to a premenopausal woman with a pT1aN0 HR+, Her2+ breast cancer?
Existing data are from convenience cohorts, but generally don't support infusional therapy for T1aN0 HER2+ tumors, who seem to do well with DRFS well above the usual threshold for intervention of 8-10%. An analysis from the MDACC database included about 250 untreated T1a-bN0 HER2+ tumors with long-t...
Is DLL3 expression necessary for tarlatamab efficacy in small cell lung cancer?
Yes- tarlatamab is a bispecific T-cell engager targeting DLL3, and thus, DLL3 expression is needed. Given the widespread expression in SCLC in approximately 90% of cases, testing for DLL3 expression prior to administering drug therapy is not required.
How do you modify the hemoglobin goal and ESA dosing for patients with sickle cell anemia and ESKD on hemodialysis?
In sickle cell patients, I coordinate care with the patient's hematologist. I will reduce the hemoglobin goal to 8-10 g/dl, and if patients have a history of crises, closer to 10 g/dl, I may choose 7-9 g/dl. ESA requirements seem to be higher in sickle cell patients, so I would start with 100 units/...
Would you consider bevacizumab for a patient with SCLC who has asymptomatic brain metastasis progression after CNS radiation while on maintenance immunotherapy?
I am assuming SCLC is small cell. I wouldn't do it now that we have agents such as tarlatamab, which has better CNS penetrance. Adding bevacizumab to atezo does have a rationale and theoretical benefit. The CeLEBrATE study, which was recently published, showed synergy between chemo, atezo, and bev, ...
For AYA patients with early-stage Hodgkin's lymphoma being treated with ABVD, how many cycles of chemotherapy do you administer, and when can radiation be avoided?
It depends - favorable/unfavorable, distribution of disease, co-morbidities, gender, family history, etc. I don't treat pediatric patients, so the comment below applies strictly to young adults.If a patient has early-stage, favorable HL per GHSG criteria (no risk factors), then 2 cycles of ABVD + 20...
What is the optimal duration of therapy in patients with metastatic colon cancer with no evidence of disease?
First of all, it sounds as if congratulations are in order for your management (to have sustained a patient with mCRC for over 5 years is truly a remarkable accomplishment, although in cases like this the self-pitying oncologist might wonder if they are victims of their own success in determining a ...
Is there a threshold absolute neutrophil count for which you would consider holding radiation?
I don't have a threshold dose for holding radiation. This decision is based on the etiology of the leukopenia. If the patient is receiving concurrent chemoradiotherapy it is usually the chemotherapy causing the issue and I rarely hold radiation even with ANC < 1000. If one were to hold both the chem...
What factors do you consider when you are deciding whether to recommend endocrine therapy for a woman who has had a mastectomy for DCIS for contralateral breast cancer risk reduction?
Endocrine therapy after a mastectomy for DCIS is primary prevention, and therefore elective. I present this as an option to decrease contralateral breast cancer risk. I quote that risk as approximately 0.7% chance per year. I generally don't recommend it for older patients or to patients with HR-neg...
What adjuvant therapy would you recommend for a cisplatin and IO ineligible patient with node positive urothelial carcinoma with mixed histology?
This is a difficult situation and I agree that there is evidence for adjuvant carboplatin-gemcitabine in cisplatin-ineligible patients with high-risk upper tract urothelial carcinoma, although benefit appeared more modest compared to cisplatin-gemcitabine (POUT trial). It is reasonable to extrapolat...