Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Are there any contraindications to BCS and adjuvant radiotherapy in patients with BARD1 mutation?
BARD1 may be a moderate risk mutation predisposing to breast cancer, but with no contraindications to breast conservation treatment. There may be a slightly increased risk of developing a new primary in the treated breast, much like any other moderate risk gene.
How would you manage asymptomatic radiographic progression from M0 CRPC to M1 CRPC to bone?
This is a relatively common scenario presently where the M0-->M1 transition is now occurring during potent AR inhibition in the nmCRPC setting. In general, I manage patients similarly to mCRPC patients progressing on an AR inhibitor and consider factors such as 1) pace of disease and symptoms, 2) co...
How would you approach maintenance therapy following chemo-immunotherapy for extensive-stage small cell lung cancer per the IMPower133 trial if there is a mixed response post-treatment but clearly some clinical benefit?
The definition of clinical benefit remains a very subjective one. We presume that the patient has had an overall good response to the combination of chemotherapy and immunotherapy, and has undergone restaging imaging during the immunotherapy alone maintenance stage. The above question would suggest ...
How do you counsel patients regarding alcohol consumption following treatment of head and neck cancer?
I always tell patients that there is no known safe amount of alcohol consumption, especially regarding the risk of developing another head and neck cancer. Most patients who consume alcohol after head and neck radiation therapy often tell me that it does not provide the same enjoyment as before due ...
What are outpatient strategies to mitigate taxane-induced peripheral neuropathy?
At the present time, there are no established means for preventing taxane-induced neuropathy other than limiting the dose that is given. In patients who are receiving taxane therapy and have developed significant neuropathy, ASCO guidelines suggest that discussion should be had with patients with re...
Would you use the pneumococcal conjugate-21 vaccine (Capvaxive) instead of the conjugate-20 (Prevnar-20) for routine vaccinations in immunosuppressed patients?
PCV-21 was recently approved by the FDA and supported by ACIP. At this early stage (August 2024), CDC has not finalized guidance on PCV-21, so we do not know how the vaccine schedule will be changed. An important distinction is that PCV-21 covers different serotypes of pneumococcus, as outlined in t...
Would you use the pneumococcal conjugate-21 vaccine (Capvaxive) instead of the conjugate-20 (Prevnar-20) for routine vaccinations in immunosuppressed patients?
PCV-21 was recently approved by the FDA and supported by ACIP. At this early stage (August 2024), CDC has not finalized guidance on PCV-21, so we do not know how the vaccine schedule will be changed. An important distinction is that PCV-21 covers different serotypes of pneumococcus, as outlined in t...
Would you continue to monitor urinary protein levels and dose adjust axitinib in a patient with metastatic malignancy who is now dialysis dependent but has residual renal function?
The question lacks specificity, so I will assume that this refers to a patient with irreversible ESRD not due to the TKI itself. Generally, if the proteinuria was exclusively due to the TKI, the HTN and proteinuria will abate when the drug is discontinued. Also, as renal function declines, the prote...
What is your approach to persistently low INR despite escalating doses of warfarin in a patient with bioprosthetic mitral valve replacement who is unable to be on DOACs?
The assumption here is that the mitral valve is mechanical, or there are presumably other reasons that a DOAC cannot be used. If this is, in fact, a mechanical mitral valve, it would make sense to start with low molecular weight heparin injections as soon as feasible while awaiting a therapeutic INR...
How would you sequence adjuvant chemo-immunotherapy (paclitaxel/carbo/pembro or paclitaxel/carbo/dostarlimab) with EBRT and vaginal cuff brachytherapy in advanced uterine cancer that meets clinical criteria for both EBRT and chemo-IO?
A common misapplication of RUBY/GY018 is giving IO in patients with non-measurable advanced uterine cancer. Radiation as part of the trial was not included in these studies. The role for chemo-IO vs chemo alone (with or without radiation) for high risk non-measurable uterine cancer was tested in GOG...