Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
At what point do you prescribe duloxetine for the treatment of AIMS (aromatase inhibitor induced musculoskeletal syndrome)?
Results from the SWOG-1202 clinical trial were recently presented in the SABCS 2016 conference in December. (Editor note: Full publication in JCO, 11/2017). Duloxetine is a SNRI approved to treat depression, anxiety, neuropathic pain, and chronic pain syndromes including fybromyalgia. This study enr...
What level of 24h urine M protein do you consider to define active myeloma in a patient with renal insufficiency, proteinuria and monoclonal gammopathy?
When in doubt, a renal biopsy is preferred to define what is the exact disease process leading to renal dysfunction. If cast nephropathy is seen, this supports a diagnosis of myeloma. If amyloid or light chain deposition disease is seen, this also supports a diagnosis of amyloidosis or MGRS/myeloma,...
What level of 24h urine M protein do you consider to define active myeloma in a patient with renal insufficiency, proteinuria and monoclonal gammopathy?
When in doubt, a renal biopsy is preferred to define what is the exact disease process leading to renal dysfunction. If cast nephropathy is seen, this supports a diagnosis of myeloma. If amyloid or light chain deposition disease is seen, this also supports a diagnosis of amyloidosis or MGRS/myeloma,...
What adjuvant therapy do you recommend for early stage poorly differentiated small cell neuroendocrine carcinoma of the cervix after surgical resection?
As Dr. @Dr. First Last has so eloquently explained, this is a rare and aggressive tumor. Often, what we think is early stage is not early stage at all. I would recommend CT or MRI brain imaging as well as a PET/CT. if there are no distant metastases, then I would offer at least 4, and up to 6 cycles...
How do you counsel patients on semaglutide or tirzepatide in light of potential cancer risks?
Use of GLP 1 RAs has sky-rocketed in recent years due to what seems to be a positive class effect on T2DM, weight loss, renal outcomes, cardiac outcomes and hepatic outcomes. I am not aware of any signals of increased malignancy risk. A brief literature review found meta-analyses showing possible be...
Based on NIAGARA data, do you now feel more comfortable offering cisplatin based chemotherapy to patients with impaired renal function?
I agree, apart from the topline positive results in the intent-to-treat population, the preplanned subgroup analysis of lower GFR patients also appears to indicate a benefit, albeit somewhat less strong than traditional criteria. This adds to evidence from the phase 3 randomized VESPER trial of ddMV...
How would you approach unresectable cutaneous angiosarcoma of the scalp?
These patients can have good outcomes with definitive chemoRT. PET and MRI brain for staging. Shave hair and have derm examine for any satellite lesions. Induction taxane-based chemo. Then chemoRT with concurrent taxol. CTV volume is controversial but needs to be generous. At a minimum, 3-5 cm in sk...
Is the currently available data from INAVO sufficient to adopt this as a new standard of care for all patients or are you awaiting overall survival and/or PROs?
The results of the INAVO120 trial are sufficient to be practice changing for patients who meet the study eligibility criteria. The improvement in progression-free survival was nearly an 8-month improvement. Although the control arm included palbociclib, which has not shown overall survival benefits ...
How do you manage copper deficiency?
Copper supplements are available. Would need to exclude zinc excess as a cause and to discontinue zinc supplements.
What treatment options would you consider for a patient with stage IV NSCLC harboring a KRAS-G12A mutation who has progressed after chemoimmunotherapy and prefers to avoid additional chemotherapy?
Unfortunately, I think the only way to avoid additional chemotherapy would be in the context of a clinical trial, where non-KRAS G12C inhibitors are being studied. From the perspective of a standard of care, I would still recommend chemotherapy. We don't have granular data to suggest dual checkpoint...