Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Is it reasonable to treat a solitary plasmacytoma of the lung parenchyma with SBRT?
I have only treated one patient with solitary plasmacytoma of the lung over the past 15 years of doing lung SBRT. It is an extremely rare and unusual disease presentation for myeloma. Given the radiosensitivity of myeloma, I opted for 30 Gy in 5 fractions, which resulted in a completed response in t...
What is your approach for adjuvant therapy when a patient has discordant Oncotype RS (e.g. <20) and MammaPrint (e.g. high risk Luminal B) in node negative HR+Her2- breast cancer?
In terms of the Mammprint, the question here is whether the patient is at low clinical risk or high clinical risk. A stage 1 patient is likely to be considered low clinical risk. In these patients, the MINDACT trial showed that Mammaprint was not able to accurately predict the benefit of chemotherap...
How do you approach recurrent migratory superficial thrombophlebitis in a patient with a negative malignancy workup and low-titer anticardiolipin antibodies?
With anticoagulation using a DOAC.
What are your top takeaways from SABCS 2023?
The B51 trial surprised the radiation oncology community, showing that in patients with an exceptional response to systemic therapy, radiation to the regional nodes did not result in a significant improvement in the invasive breast cancer recurrence free interval nor the isolated loco-regional recu...
What is the best first line treatment for stage IV pancreatic squamous cell carcinoma?
This is a challenging question as there are limited data on the optimal therapy for rare histologies of the pancreas (with the exception of neuroendocrine tumors). Experiences are limited to case reports, and in general this histology seems to have a worse prognosis than adenocarcinomas of the pancr...
What are your top takeaways in Breast Cancer from ESMO 2024?
The most interesting and impactful paper was LBA18 – DESTINY-Breast12 showing significant responses in HER2+ brain metastases – including untreated brain metastases. The median PFS and survivals were truly impressive Abstract 3400, testing patritumab (HER3-targeting antibody-drug conjugate) in a Pha...
Would you evaluate for thrombophilia in patients with incidental splenic infarcts in the setting of known cirrhosis, portal hypertension, and splenomegaly?
When approaching splenic infarction, one question is to attempt to discern if the infarction is due to venous thrombosis (e.g., in the splenic vein) and subsequent congestion or due to arterial thrombosis (e.g. in the splenic artery), which is much more common. Talking with an expert diagnostic radi...
Do you stop consolidative durvalumab after one year as per the PACIFIC trial or continue if the patient is otherwise tolerating well?
The purpose of definitive therapy with chemoradiation followed by durvalumab is cure. The overall survival was significantly improved in those who received durvalumab for a year in the PACIFIC study. The follow up remains immature, but this data suggests that more patients with stage III lung cancer...
What is your approach to choosing a conditioning regimen for allogeneic transplant in AML?
Randomized trials in AML and to a lesser degree in MDS have shown that dose intensity is important for long term disease control. Following the guiding principle of trying to optimize the conditioning for each individual patient I use the following guidelines 1 patients less than 60 with HCTCI 3 or...
What is your approach to choosing a conditioning regimen for allogeneic transplant in AML?
Randomized trials in AML and to a lesser degree in MDS have shown that dose intensity is important for long term disease control. Following the guiding principle of trying to optimize the conditioning for each individual patient I use the following guidelines 1 patients less than 60 with HCTCI 3 or...