Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Do you hold or dose modify chemotherapy with BEP or EP for severe cytopenia or renal injury when treating testicular cancer in the curative setting?
No. In terms of cytopenias on day 22, it is usually granulocytopenia that concerns treaters. I look at the CBC and you will usually see a left shift c/w rapid recovery. If one is very concerned, you can add a granulocyte stimulating factor for this cycle. In terms of renal function, I would again ...
Does 4G/5G polymorphism in the plasminogen activator inhibitor (PAI-1) gene increase the risk of thrombosis?
Venous thromboembolism (VTE) is a classical example of a multifactorial disorder where genetic and environmental factors interact to result in VTE. Of the genetic disorders, in isolation, many are weak risk factors but when combined with other genetic or one or more environmental risk factors increa...
Does 4G/5G polymorphism in the plasminogen activator inhibitor (PAI-1) gene increase the risk of thrombosis?
Venous thromboembolism (VTE) is a classical example of a multifactorial disorder where genetic and environmental factors interact to result in VTE. Of the genetic disorders, in isolation, many are weak risk factors but when combined with other genetic or one or more environmental risk factors increa...
Would you discontinue or dose-reduce tamoxifen in a patient who developed hepatic steatosis?
In the absence of liver enzyme elevation and other risk factors for developing hepatic steatosis (such as obesity and dietary habits), I would be comfortable continuing tamoxifen. However, if tamoxifen-associated hepatic injury is suspected, my preference would be to discontinue tamoxifen or change ...
For metastatic clear cell RCC, would you consider cabozantinib + nivolumab after progression on first line ipilimumab + nivolumab?
The management of metastatic clear cell RCC continues to evolve since the approval of nivolumab for salvage therapy post TKI tx. Given the activity of anti PD1 inhibition in the salvage setting, the field has investigated multiple combinations of such agents in the first line setting. The rationale ...
Is there any benefit of using aspirin to mitigate VTE risk in testosterone-induced polycythemia?
Erythrocytosis is a common adverse effect of testosterone therapy, and results from several studies suggest an association between elevated hematocrit (Hct) and risk of VTE (Braekkan et al., PMID 19833630; Ory et al., PMID 35050717). There is currently no data to support the routine use of aspirin o...
Is there any data to use PIK3CA-directed agents in mutated metastatic triple-negative breast cancer?
PIK3CA inhibitors are not currently approved for use in patients with triple-negative (ER, PR, and HER2-negative) breast cancer. There is preclinical and early clinical work that indicates promise in patients with ER/PR negative, HER2 negative, PIK3CA mutated breast. A quick search finds that there ...
Are there scenarios where you would still prefer adjuvant nivolumab based on known pathologic risk over using perioperative durvalumab for patients with muscle invasive bladder cancer?
Adjuvant nivolumab can still be considered for patients who fit the criteria for CheckMate 274, which led to the approval of this regimen. Specifically, this refers to patients who have not had perioperative chemotherapy and have high-risk disease at the time of radical cystectomy (≥pT3N0) or patien...
How would you treat a patient with metastatic Leydig cell tumor of the testes with extensive lung and abdominal metastases (peritoneum, retroperitoneal LN and soft tissue) following orchiectomy and maximal surgical resection of abdominal disease?
Nongerm cell tumors of the testis ( Leydig, Sertoli or sex cord stromal tumors) are not curable when metastatic when they are inoperable, as the case here. I would sequence his tumor to check for a targetable mutation, but this would provide a less toxic and hopefully more effective alternative to c...
How do you approach a patient with inoperable urothelial carcinoma of the bladder with persistent non-muscle invasive disease despite intravesical BCG/IFN and intravesical chemotherapy?
T1 high grade urothelial carcinoma, with persistent disease after intra-vesicular therapy (e.g., BCG) is an aggressive disease and progression to invasive urothelial cancer is common. This entity tends to be multifocal / diffuse and transurethral resection (TURBT) alone is often inadequate as defini...