Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
What is the role of anticoagulation in patients with septic thrombophlebitis?
The role of heparin anticoagulation in septic thrombophlebitis is controversial. There are limited to no randomized trials to document outcomes. A systematic review (Falagas et al., PMID 17222406) supported this practice, and the Infectious Disease Society also supports this practice. The role of or...
For a patient who is cisplatin-eligible with localized, high-grade upper tract urothelial carcinoma, but no muscularis propria seen on biopsy, what is your approach?
The risk of clinical under-staging is notorious in UTUC; therefore, we aim to maximize control of disease and address the meaningful risk of micro-metastasis. In that context and outside clinical trial option, we favor the use of neoadjuvant cisplatin-based chemotherapy using either dose dense MVAC ...
Is a tumor ever too small to send off a genomic assay like Oncotype or Mammoprint in HR positive, HER2 negative stage 1 breast cancer?
The Oncotype DX has been used to identify high risk stage T1b tumors that may benefit from the addition of chemotherapy such as Taxotere/Cytoxan for 4 cycles and has been part of NCCN guidelines for quite some time. We do consider chemotherapy for high risk T1b luminal B tumors (either on basis of h...
How do you interpret elevations in ESR and CRP in the setting of increased BMI?
Increases in BMI (overweight and obesity range) have been shown to be associated with elevated CRP and ESR, with stronger associations shown with CRP specifically. Interestingly, the association between elevated CRP and obesity seems to be stronger in female populations than in male patients.In the ...
How do you interpret elevations in ESR and CRP in the setting of increased BMI?
Increases in BMI (overweight and obesity range) have been shown to be associated with elevated CRP and ESR, with stronger associations shown with CRP specifically. Interestingly, the association between elevated CRP and obesity seems to be stronger in female populations than in male patients.In the ...
How should one monitor for and manage CMV reactivation in patients receiving alemtuzumab?
Here's how I approach it: Baseline Testing: Perform CMV serology (IgG/IgM) and quantitative CMV DNA PCR before initiating alemtuzumab to establish baseline status. Frequency: Weekly PCR testing for 8–12 weeks post-infusion, focusing on the high-risk window (weeks 3–6). Extend monitoring ...
How do you counsel patients with Stage IIIA EGFR+ lung cancer regarding treatment intent with concurrent chemoRT + consolidative systemic therapy?
I think one of the crucial take-home points from the LAURA clinical trial (Lu et al., PMID 38828946) is how often we (the medical oncology community) tell patients we are treating them with "curative intent" but ignore the incredibly high relapse risk among patients with EGFR mutant NSCLC with stage...
What are your top takeaways in Breast Cancer from ASCO 2024?
1. DESTINY-Breast06 This phase 3 trial randomized patients to either Trastuzumab deruxtecan (T-DXd) vs. physician’s choice chemotherapy (capecitabine, nab-paclitaxel, paclitaxel) in hormone receptor positive HER2 low or HER2 ultralow (any membrane staining) metastatic breast cancer after prior endoc...
When do you start ADT for a patient with a new diagnosis of node positive prostate cancer receiving radiation?
We usually start upfront and start RT in a few months. This helps to see nodal response, can also sometimes help meet small bowel constraints with regression, and can also adjust the total dose if needed. ASTRO 2022: Predictive Value of Ga68-PSMA PETCT-Based Response to Neoadjuvant Androgen Deprivat...
Do you plan to extrapolate from the NIAGARA trial regarding peri-operative durvalumab/cis/gem to treat upper tract urothelial carcinoma?
UTUC has different biology from MIBC and is considered more aggressive. Patients with UTUC were excluded from the NIAGARA, and therefore, we cannot make assumptions and extrapolations. Having said that, in patients with UTUC, it is important to check if they have microsatellite instability or Lynch ...