Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
What first line therapeutic regimen do you consider most appropriate for metastatic clear cell renal carcinoma presenting with brain metastasis and vasogenic edema?
Yes, it is safe, but I always treat the CNS metastasis first (e.g. SRS). The risk of bleeding in an untreated CNS metastasis with a VEGF TKI is otherwise unacceptable in my opinion. The edema should be treated with steroids as appropriate and I haven't experienced TKIs worsening CNS edema.
Do you treat muscle-invasive urothelial bladder cancer with plasmacytoid features any differently in terms of the recommendation for neoadjuvant cisplatin-based chemotherapy?
Plasmacytoid variant carcinoma is a rare aggressive variant that tends to be chemosensitive but recurs frequently and is characterized by CDH1 loss of function genomic alterations and peritoneal metastasis. In predominant plasmacytoid urothelial carcinoma, the role of neoadjuvant chemotherapy (NAC) ...
How do you decide between radioligand therapy or cytotoxic chemotherapy in patients with metastatic castration-resistant prostate cancer with prior ARPI exposure who have cancer-related anemia?
Radioligand therapy (presumably the question refers to Lu-177 vipivotide tetraxaten/Pluvicto) is one of the latest and most promising treatments for mCRPC. As in all cancer treatments, the practitioner needs to have a good understanding of adverse event likelihood, but also the potential for benefit...
Do you use anti-microbial prophylaxis when you prescribe ibrutinib?
Traditionally, H.Zoster and PJP prophylaxis was more routinely administered in CLL patients receiving chemoimmunotherapy as these regimens were typically more myelosuppressive as well as immunosuppressive. In the era of the novel BCR receptor agents with the approval of ibrutinib and idelalisib and ...
Do you use anti-microbial prophylaxis when you prescribe ibrutinib?
Traditionally, H.Zoster and PJP prophylaxis was more routinely administered in CLL patients receiving chemoimmunotherapy as these regimens were typically more myelosuppressive as well as immunosuppressive. In the era of the novel BCR receptor agents with the approval of ibrutinib and idelalisib and ...
What is the optimal management of a patient with refractory TTP who has had poor response to plasma exchange, steroids, rituximab, especially when caplacizumab is unavailable?
Caplacizumab would obviously be the best thing right now, but if unavailable, there are some data with cyclosporine as well as bortezomib and cyclophosphamide to help with more refractory disease. These measures, unfortunately though, will take some time to have an effect. Intensification of plasma ...
Would you offer any adjuvant therapy for a young patient with anal cancer s/p definitive chemoradiation and R0 resection with significant residual disease?
We do not have complete details regarding the clinical history of this case. For instance, information about the patient’s initial response to chemoradiation—whether residual disease was identified early or if this represents a local recurrence after an initial favorable response—would be important ...
How do you reconcile discrepancies in clinical prostate cancer staging with AJCC and NCCN?
Fundamentally, I use NCCN risk categories to help steer conversations about staging and treatment options for very low vs low vs fav int vs unfav int vs high risk diseases. Therefore, I use NCCN staging in my clinical practice and notes and incorporate mpMRI into staging. I find it comforting that N...
Is 5fx APBI and no endocrine therapy a new standard of care for women over 70 years old with low-risk breast cancer given the interim analysis of the EUROPA trial?
How do you ask a woman to be the last woman to suffer for an unlikely, non-lethal recurrence? For women with low-risk breast cancer, endocrine therapy does not improve survival and is less effective at decreasing recurrences—we saw this in NSABP B-21. Yet it causes years of suffering: arthralgia, ho...
What is the expected timeframe for the development of radiation myelitis and therapies that have helped with neurologic symptoms?
The incidence and the timeframe of the development of radiation myelopathy are influenced by total radiation dose, radiation dose per fraction, time between courses of radiation, and associated chemotherapy or immunotherapy. Older age, the presence of diabetes, and previous exposure to radiation are...