Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Which patients with relapsed/refractory NHL are appropriate for pre-CAR-T bridging radiation therapy?
Before answering this important question, I think that we, as Radiation Oncologists, should give serious consideration to moving past the terminology of "bridging radiation therapy" and instead refer to it as "pre-CAR-T infusion radiation therapy." Bridging therapy was initially an apt name; we were...
Which patients with relapsed/refractory NHL are appropriate for pre-CAR-T bridging radiation therapy?
Before answering this important question, I think that we, as Radiation Oncologists, should give serious consideration to moving past the terminology of "bridging radiation therapy" and instead refer to it as "pre-CAR-T infusion radiation therapy." Bridging therapy was initially an apt name; we were...
When would you feel comfortable with patients who have a history of hormone-receptor positive breast cancer using hormonal IUDs (e.g. Mirena)?
While we typically recommend removing progesterone-secreting IUDs in patients with ER+ breast cancer, especially while receiving chemotherapy or adjuvant endocrine therapy, there is no data that I am aware of to support this recommendation, and we sometimes administer a systemic progestin (megestrol...
How would you manage a patient with marginal zone lymphoma who progress after treatment on a BKTI?
Was the BTKi the first line of therapy? If so, many options remain: 1) anti-CD20 alone if relatively low volume disease, 2) BR/BO, or 3) Len-rituximab. I guess one could now consider Len-ritux-tafa based on InMIND, but marginal zone enrollment was small and the schedule is not easy.
How would you manage a patient with a recent diagnosis of advanced DLBCL (non-GCB subtype) who has baseline grade 3 neuropathy?
Avoid neurotoxic agents. Substitute pola; avoid vincristine.
How would you manage a frail patient with GCB DLBCL who is unable to complete R-CHOP but has moderate residual disease?
We need a little more information to answer this question. First, what was the stage at diagnosis? Why is the patient frail - is this disease related, or is this a result of therapy? The age of the patient can also assist in making this decision. Also, what is the moderate disease? Can this be inclu...
Would you add immunotherapy to chemotherapy for a patient with metastatic NSCLC, an atypical EGFR mutation, and PD-L1 ≥50% who has progressed on osimertinib?
This is a difficult scenario, and there is no data to guide this. There is good evidence to suggest that patients with the classical mutations do not respond to ICIs regardless of PD-L1 expression. There is one small retrospective analysis that included 7 patients with uncommon mutations (G719X and ...
Is there evidence to support bladder preservation therapy in node positive bladder cancer?
Although there aren’t randomized data suggesting the superiority of trimodality therapy (TMT) over any other treatment for N+ bladder cancer, I think most feel that it is the standard of care as alluded to in the question. Broadly speaking, patients and providers have two options: radical therapy or...
How do you decide between maintenance avelumab vs CRT for patients with N2-3 bladder cancer who have SD or PR after platinum induction?
For patients with N2-N3 disease who have a clinical PR or SD with platinum-based chemotherapy, switch maintenance avelumab would be quite reasonable since such patients were eligible for the JAVELIN Bladder-100 phase III trial (and benefit was seen regardless of PD-L1 status, although benefit appear...
What would you offer for a very young patient with metastatic renal medullary carcinoma who has progressed on cisplatin-based chemotherapy?
Doxorubicin-based regimens (per our study here) adapted to context and EGFR-targeted therapies (see here, but do not use bevacizumab as discussed here and here) with prioritization for panitumumab-based therapy as discussed here (from 5:00 onwards) and in yesterday's IKCS: NA session on rare kidney ...