Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Is there evidence to support bladder preservation therapy in node positive bladder cancer?
Although there aren’t randomized data suggesting the superiority of trimodality therapy (TMT) over any other treatment for N+ bladder cancer, I think most feel that it is the standard of care as alluded to in the question. Broadly speaking, patients and providers have two options: radical therapy or...
How do you decide between maintenance avelumab vs CRT for patients with N2-3 bladder cancer who have SD or PR after platinum induction?
For patients with N2-N3 disease who have a clinical PR or SD with platinum-based chemotherapy, switch maintenance avelumab would be quite reasonable since such patients were eligible for the JAVELIN Bladder-100 phase III trial (and benefit was seen regardless of PD-L1 status, although benefit appear...
What would you offer for a very young patient with metastatic renal medullary carcinoma who has progressed on cisplatin-based chemotherapy?
Doxorubicin-based regimens (per our study here) adapted to context and EGFR-targeted therapies (see here, but do not use bevacizumab as discussed here and here) with prioritization for panitumumab-based therapy as discussed here (from 5:00 onwards) and in yesterday's IKCS: NA session on rare kidney ...
When do you refer a patient with recurrent glioma for reoperation?
This question is a nuanced one that is dependent on many factors. When a patient has a recurrent glioma, the treatment options are generally re-resection, medical therapy (traditional chemotherapy or targeted agents, depending on the tumor), or radiation. Which treatment modality, or combination of ...
In addition to monitoring hemoglobin and supplementing folic acid, what is your approach to hereditary spherocytosis in pregnancy?
I use the same transfusion threshold for the general pregnant population but I do refer to maternofetal medicine/high risk pregnancy clinic for closer fetal monitoring. My personal preference is to obtain genetic testing to confirm the specific mutation responsible for hereditary spherocytosis as it...
How do you manage B12 deficiency refractory to subcutaneous replacement?
I tend to start with IM injections of B12 when patients are severely deficient. The most common mistake in replacing severely low B12 is to not load, or to check levels too early. I have not used SQ administration before. It should absorb, but if you are having issues I would go to IM and start week...
What is the role of liver transplant in NET?
Identifying the role of liver transplant (txp) in NET patients with all the other therapy options available is challenging. I will admit that there have been several years since I last was involved in the care of a patient that actually ended up having a liver txp. That said, I think certain patient...
Would you give GO and/or a FLT3 inhibitor for patients with AML with t(8;21) and FLT3-ITD low in addition to 7+3?
First, in terms of risk stratification, core binding factor (CBF) AML [whether inv16 or t(8;21)] is considered to be favorable risk by ELN22 even if a FLT3 mutation is present (Döhner et al., PMID 35797463). The incidence of FLT3-ITD in CBF-AML is 5-10% (Faber et al., PMID 27798625). There are some ...
Would you give GO and/or a FLT3 inhibitor for patients with AML with t(8;21) and FLT3-ITD low in addition to 7+3?
First, in terms of risk stratification, core binding factor (CBF) AML [whether inv16 or t(8;21)] is considered to be favorable risk by ELN22 even if a FLT3 mutation is present (Döhner et al., PMID 35797463). The incidence of FLT3-ITD in CBF-AML is 5-10% (Faber et al., PMID 27798625). There are some ...
With the addition of pembrolizumab following chemoradiation per KEYNOTE-A18, would you be less likely to treat the paraaortic chain prophylactically?
I would favor the same volume of RT with or without pembro. If there is an indication to treat PA nodal chain, would treat as per plan.