Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Would you extend the duration of anticoagulation in patients with a provoked DVT, but evidence of residual clot at 3 months?
This is a really interesting discussion. I do tend to get Dopplers at the end of the anticoagulation treatment period, but only to assess the new baseline and to help decision-making in the future if they develop new symptoms and have another Doppler. I find this to be very helpful to understand if ...
What would be your recommended regimen for an AYA patient with relapsed mediastinal pure seminoma, with relapse 20 months after completion of BEP?
Mediastinal seminoma is rare and has a high cure rate with chemotherapy alone (BEP x3). I would refer a patient like this to a high-volume center. Treatment options are high-dose chemotherapy followed by ASCT vs. resection. This should be a tumor board discussion. Despite limited data and the interv...
In patients with post-PV myelofibrosis who are ineligible for allogeneic stem cell transplant, how do you approach symptomatic splenomegaly refractory to splenic radiation and ruxolitinib?
This is always a tough situation. First, I would make sure the patient is truly not a candidate for transplant. With reduced intensity conditioning and the addition of ruxolitinib before and after transplant, transplant is better tolerated than it once was. Otherwise, would consider switching to ano...
In patients with post-PV myelofibrosis who are ineligible for allogeneic stem cell transplant, how do you approach symptomatic splenomegaly refractory to splenic radiation and ruxolitinib?
This is always a tough situation. First, I would make sure the patient is truly not a candidate for transplant. With reduced intensity conditioning and the addition of ruxolitinib before and after transplant, transplant is better tolerated than it once was. Otherwise, would consider switching to ano...
How would you approach management and monitoring of AL amyloidosis with isolated renal involvement?
This is tough for sure, and my first question would be to ask how the renal biopsy was determined to be AL amyloidosis. Sometimes typing isn't required if the pattern is overwhelmingly lambda-restricted or kappa-restricted by immunofluorescence... but in this case, mass spectrometry typing may be wo...
How would you approach management and monitoring of AL amyloidosis with isolated renal involvement?
This is tough for sure, and my first question would be to ask how the renal biopsy was determined to be AL amyloidosis. Sometimes typing isn't required if the pattern is overwhelmingly lambda-restricted or kappa-restricted by immunofluorescence... but in this case, mass spectrometry typing may be wo...
For early-stage, HR+ Her2- breast cancers, when do you use OncotypeDx v. Mammaprint?
The reason to use any multiparameter assay is to determine which patients need chemo and which don't. To say that another way - it is about the predictive ability, not the prognostic ability. Until very recently, Mammaprint only had prognostic data so I always used Oncotype. The MINDACT trial recent...
Would you consider a cycle of EP in a patient with good risk stage IIIB seminoma on BEP but with bleomycin omitted for cycle 3?
There are many aspects to this question. Good risk stage II seminoma has a 90-99% cure rate. I presume he has had all 3 five day courses of the EP component and 6 of 9 weeks of bleomycin. An ECOG study from about 30 (!) years ago compared BEP X 3 versus 3 courses EP for all types and histologies of...
Would you consider anthracycline based neoadjuvant therapy for ER negative, HER2 positive inflammatory breast cancer in a premenopausal female given the subset not adequately represented in non-anthracycline regimen trials?
The TRAIN-2 study of non-anthracycline vs. anthracycline-based chemotherapy for HER2 positive disease did include inflammatory breast cancer and found no benefit of anthracycline-based chemotherapy over non-anthracycline based chemo. I would not give anthracycline to a HER2-positive patient just bec...
For patients with triple negative breast cancer who have a minimal response to neoadjuvant chemotherapy, do you do additional testing to sub-categorize the cancer and find a potential target (e.g. androgen receptor, etc)?
We often encounter this scenario when we have residual disease after Neo-adjuvant chemotherapy in TNBC and I think about these 3 options: ECOG Trial/ NCT02445391: Phase III Trial randomizing Platinum (4 cycles of cisplatin or Carboplatin) versus oral Capecitabine x 6 cycles. (Requires residual disea...