Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Is there any role for early stem cell mobilization and collection during the SMM phase?
Prolonged exposure to lenalidomide can affect the ability to mobilize and collect stem cells, though this is less of an issue with increasing use of plerixafor (Giralt et al., 2009). If you are going to treat with an IMD, it is important to collect stem cells after 4-6 months of therapy, similar to ...
How would you treat newly diagnosed good risk stage III seminoma with hearing loss?
In order to treat a newly diagnosed stage 3 seminoma in a hearing-impaired patient, my first step is to have the pathology confirmed by an expert GU-tumor pathologist to ensure that this is not actually NSGCT nor large cell lymphoma. While that is in process, I ensure that baseline tumor markers hav...
Do you consider MSI testing for mCRPC?
I agree that data for response to immunotherapy in MMR-deficient (dMMR) prostate cancer is limited, and we estimate the rate of dMMR in prostate cancer to be low, in the 2-3% range. Nonetheless, based on responses in other dMMR tumors, pembrolizumab is now FDA approved for all dMMR/MSI-high unresect...
Despite the paucity of strong data showing benefit of chemotherapy + radiotherapy in patients with stage I-II high risk histology endometrial cancer, if you recommend treatment with both modalities, how do you determine treatment schedule?
For the purpose of this answer, I'll define high risk as serous, carcinosarcoma, undifferentiated, and dedifferentiated. Clear cell carcinoma can be considered and likely treated more by its molecular profile. As you indicate, there is little data to support the routine use of chemotherapy for FIGO ...
What is your approach to chronic non-immune mediated thrombocytopenia management in children?
There are whole textbook chapters on this topic, and we use a variant of this question to review the differential diagnosis of thrombocytopenia with our fellows as a didactic exercise. So I take from this question, which is an important one, what might be a framework to consider the differential dx ...
How do you stage patients with testicular cancer who may have CSIS disease?
This always looks easy, but you have to be careful and have patience. Some mistakes occur because providers use the PRE-orchiectomy markers or immediate post-orchiectomy markers before they have a chance to normalize. Also, providers sometimes react to low abnormal stable markers which often are fal...
What is your current practice for obtaining mutation status for a patient with newly diagnosed ovarian cancer?
My current practice is to test all newly diagnosed epithelial ovarian cancer patients (includes fallopian tube and peritoneal) with both germline multigene and somatic multigene/NGS panels. Only recently have I adopted the practice of concurrent testing at diagnosis rather than basing the decision t...
What are the recommended second-line treatment options for patients with metastatic HER2+ breast cancer who have received frontline trastuzumab deruxtecan (T-DXd)?
There is currently limited direct evidence to guide optimal sequencing after frontline trastuzumab deruxtecan, so second-line treatment decisions are individualized. In many cases, the HER2CLIMB regimen with tucatinib, capecitabine, and trastuzumab is an appealing option, particularly for patients w...
Do you continue daratumumab beyond 24 months in first line treatment of amyloidosis?
This is an important and common clinical question, and one for which prospective data are currently limited. For background, the ANDROMEDA clinical trial (Kastritis et al., PMID 34192431) demonstrated that the addition of daratumumab to cyclophosphamide, bortezomib, and dexamethasone (CyBorD) signif...
Do you continue daratumumab beyond 24 months in first line treatment of amyloidosis?
This is an important and common clinical question, and one for which prospective data are currently limited. For background, the ANDROMEDA clinical trial (Kastritis et al., PMID 34192431) demonstrated that the addition of daratumumab to cyclophosphamide, bortezomib, and dexamethasone (CyBorD) signif...