Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
What are the factors that you would consider for the use of ESA in patients with anemia of CKD with a history of stroke or TIA?
Large clinical trials of ESA have indicated increased stroke risk with these medications with TREAT reporting the highest stroke incidence. In this study, "baseline history of cerebrovascular disease was a strong predictor of experiencing a stroke during follow-up; patients with a history of stroke ...
Would you recommend adjuvant chemotherapy for a Stage II colon cancer patient who has negative ctDNA but presented with obstruction?
I often tell my patients that, where the field of liquid biopsy is at present, we have not too many concerns about the positive ctDNA results. It’s the negative ctDNA results that one has to be careful with.In general, if there’s a strong clinical reason to give adjuvant, I don’t rely on ctDNA to ch...
How would you treat an older patient with B symptoms and biopsy consistent with grade 3 follicular lymphoma but noted to have a PET scan with SUV readings of > 20?
If an adequate biopsy was performed of the most active (high SUV) mass/node and results as follicular grade 3 A, then can treat as you would a follicular lymphoma with BR. I have seen high SUVs with follicular lymphoma. Mir et al., PMID 31961926However, if it is follicular grade 3 B or has high Ki67...
How would you treat an older patient with B symptoms and biopsy consistent with grade 3 follicular lymphoma but noted to have a PET scan with SUV readings of > 20?
If an adequate biopsy was performed of the most active (high SUV) mass/node and results as follicular grade 3 A, then can treat as you would a follicular lymphoma with BR. I have seen high SUVs with follicular lymphoma. Mir et al., PMID 31961926However, if it is follicular grade 3 B or has high Ki67...
When, if ever, would you consider use of nivo/ipi for favorable risk metastatic ccRCC?
I do think about nivo/ipi for a subset of patients with favorable risk disease -- usually younger patients who are shooting for a complete response. In the favorable risk subset of patients in CheckMate 214, the complete responses are higher than even in the intermediate-poor risk. Patients who have...
What are your top takeaways in GU Cancers from ASCO 2025?
Here are the top 3 prostate cancer studies: AMPLITUDE. LBA5006: Attard and colleagues show that the PARP inhibitor niraparib plus abiraterone/prednisone delayed rPFS in men with mHSPC (HR 0.63, p = 0.0001), meaning this is the first ARPI/PARPI successful combination in this hormone-sensitive HRRm se...
What is your first line of therapy for refractory Hodgkin lymphoma in an AYA patient?
Our first approach in this setting is second line chemotherapy with the intention to achieve a complete metabolic remission (by PET) and then an autologous stem cell transplant. Our approach to the transplant includes total lymphoid irradiation followed by a conditioning regimen of Cyclophosphamide,...
What is your first line of therapy for refractory Hodgkin lymphoma in an AYA patient?
Our first approach in this setting is second line chemotherapy with the intention to achieve a complete metabolic remission (by PET) and then an autologous stem cell transplant. Our approach to the transplant includes total lymphoid irradiation followed by a conditioning regimen of Cyclophosphamide,...
What is your approach to the adjuvant treatment of early-stage mixed-histology endometrial cancer with a significant clear-cell component?
Clear cell carcinomas are under-represented in most clinical trials and hence, clear evidence-based recommendations are difficult to make. Even a small percentage of clear cell is sufficient to label these as “high grade”. The recently published ASTRO guidelines mention that chemotherapy may not ben...
Is switching to carboplatin/gemcitabine reasonable for a patient with muscle invasive bladder CA who proceeded to cystectomy first and had AKI with cisplatin/gemcitabine prohibiting further cisplatin?
There is not a role for gemcitabine and carboplatin in the adjuvant setting in patients with muscle invasive bladder cancer. Based on CheckMate 274 (Bajorin et al., PMID 34077643), in patients with MIBC with a high risk of recurrence (pT3, pT4a, or pN+ and not eligible for or declined adjuvant cispl...