Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Is there a role for extended adjuvant neratinib with pCR after neoadjuvant chemotherapy in triple positive breast cancer?
The benefit of adjuvant neratinib is generally proportional to the residual risk of recurrence following definitive therapy including HER-targeted adjuvant therapy. In the ExteNET study final efficacy report, the absolute difference in overall survival at 5 years was estimated at 9.1% in 295 patient...
How have you used Hedgehog pathway inhibitors as neoadjuvant/adjuvant therapies?
I am presuming that the question is directed towards Basal cell cancer. We don't use Hedgehog pathway inhibitors (HHIs) in an adjuvant setting, but sometimes in the neoadjuvant setting, when the risk of getting a positive margin is high. I prefer alternate-day dosing of vismodegib (less muscle cramp...
What dose constraints do you use when treating gastric MALT or DLBCL with radiation therapy?
Treatment of the entire stomach is recommended for gastric MALT lymphoma. A dose of 24-30 Gy is recommended, generally in 1.5 Gy fractions to limit acute toxicity. I am starting to utilize 24 Gy more frequently though, most studies have used 30 Gy. Gastric MALT tends to be multifocal, is not well vi...
How do you prescribe a steroid taper for radiation and checkpoint inhibitor related pneumonitis?
I subscribe to the philosophy of "hitting hard, tapering slowly" for cases of pneumonitis, either radiation pneumonitis, or checkpoint inhibitor-related pneumonitis (some of those cases probably have mixed origin, with contributions from radiation and/or checkpoint inhibitors). For severely symptoma...
What is your surveillance protocol for patients with common variable immunodeficiency receiving chronic IVIG therapy?
No target IgG level per se- dose/interval should be titrated to clinical condition. In general, trough IgG on treatment should be higher than 500 mg/dL, or 500 mg/dL higher than baseline. Most patients will not be in optimal clinical condition (minimal fatigue, arthralgias, absence of chronic cough,...
What is your surveillance protocol for patients with common variable immunodeficiency receiving chronic IVIG therapy?
No target IgG level per se- dose/interval should be titrated to clinical condition. In general, trough IgG on treatment should be higher than 500 mg/dL, or 500 mg/dL higher than baseline. Most patients will not be in optimal clinical condition (minimal fatigue, arthralgias, absence of chronic cough,...
Do you use MRD testing to guide maintenance therapy discontinuation in newly diagnosed non-high risk myeloma patients?
Major bias, incoming!The short answer is: yes, I use MRD to guide de-escalation and ultimately discontinuation in standard-risk patients with myeloma.Much of that sentiment comes from our work at the University of Chicago called MRD2STOP, where we allow patients to stop treatment if they are sustain...
Do you advise patients with a personal or family history of germ cell tumors to avoid endocrine disruptors such as marijuana/CBD, lavender oils, or tea tree oils?
No, I do not advise against MJH or other putative endocrine disruptors, other than cautioning against the general health effects of MJH. I assume the question was triggered by the concern regarding older reports of an association of MJH and the development of germ cell tumors. Several things: Our un...
How would you approach a patient who is unable to undergo the recommended ophthalmologic examinations during treatment with mirvetuximab soravtansine?
Until more data are available regarding the ocular safety and reviewed by the agency, I follow the recommendations. I feel there is a decent chance real-world experience may change this but officially I follow the recommendations as stated. Having said this, the testing recommended (“Conduct an opht...
In patients with NCCN-defined very high risk localized prostate adenocarcinoma who have a contraindication to abiraterone plus prednisone, do you consider starting ARPI (such as enzalutamide) instead, in addition to ADT?
Absolutely. Abiraterone in this setting improves OS, MFS, and likely long-term remission/cure rates over 10+ years when combined with radiation and standard of care radiation. Suppose a patient cannot tolerate abiraterone or prednisone due to various comorbidities (e.g., diabetes, steroid intoleranc...