Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
What chemotherapeutic regimen would you prefer in patients with T1N0 triple-negative breast cancer, assuming no contraindications to taxanes and anthracyclines?
In the joint analysis of the ABC (Anthracyclines in early Breast Cancer) presented at ASCO 2016 there was a 30% relative increased risk of invasive recurrence for women with ER/PR-negative, node-negative disease when an anthracycline was omitted (HR 1.31). Further subset analyses by tumor size were ...
Which imaging modalities and schedule do you use to follow stage I-II follicular lymphoma that was treated with radiotherapy alone?
PET has been demonstrated to be more sensitive and specific in staging for FL as well as a strong independent predictor of outcome after treatment. Patients also have ~50% risk of developing recurrence outside the RT volume - and PET allows for whole-body imaging. PET is therefore the imaging modali...
How long would you continue chronic transfusion therapy for adult sickle cell patients who have had a stroke?
There is no high-level evidence to inform the decision of how long to continue chronic transfusion in this scenario. Decisions on whether to continue indefinitely are affected by multiple factors like the presence of RBC alloimmunization, whether the patient was on hydroxyurea at MTD or not at the t...
Do you repeat antiphospholipid antibody testing in a patient that previously met criteria for APLS?
I would repeat APL Ab testing if I am trying to risk stratify a patient in preparation for pregnancy or surgery, for example. In some cases (see a recently posted question about stopping anticoagulation in people with prior APLS history), I would also consider rechecking if I am thinking about disco...
Would you retry rituximab in steroid refractory warm autoimmune hemolytic anemia which responded to rituximab before?
Yes, I would utilize rituximab a second time for treatment of AIHA in light of a response during the first episode. The first response was not that durable in this case, and it would be anticipated the response after the second round of rituximab may not be even as durable as the first. As usual wit...
Does ASC4FIRST data justify the use of first-line asciminib for all newly diagnosed CML over other TKIs, considering that post-progression survival data is not yet mature?
Ideally, every patient gets the newest and greatest, but the elephant in the room is asciminib’s $145,000 per year cost compared to imatinib’s $600.
Does ASC4FIRST data justify the use of first-line asciminib for all newly diagnosed CML over other TKIs, considering that post-progression survival data is not yet mature?
Ideally, every patient gets the newest and greatest, but the elephant in the room is asciminib’s $145,000 per year cost compared to imatinib’s $600.
How do you approach treatment for solitary fibrous tumor with a multifocal pleural-based metastatic recurrence that is surgically inoperable in a patient with good performance status?
Standard sarcoma chemotherapy does NOT work unless SFT has dedifferentiated into a frank sarcoma. For SFT, VEGFR inhibition helps. Options tested are temozolomide/bevacizumab (Park, et al. Cancer 2011), sunitinib or pazopanib.
When, if ever, do you use capecitabine/temozolomide in metastatic high grade neuroendocrine carcinoma?
CAPTEM has a relatively minimal role in the management of neuroendocrine carcinoma (NEC) and is almost exclusively used in later lines of therapy after first-line platinum/etoposide. In general, second-line therapy of NEC is ineffective and a retrospective study of 64 patients receiving various regi...
Do you recommend using Oncotype Dx prior to hormonal or cytotoxic neoadjuvant therapy in LN negative, ER positive/Her2 negative breast cancer?
Both chemotherapy and endocrine therapy pre-operatively have been shown to improve breast conservation rates. This may not be as well appreciated in the case of hormonal therapy - while complete pathological responses are clearly more often seen with chemotherapy, the relative odds of having breast-...