Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
In which cases would you consider early transition to DOAC (within 72 hours) for hospitalized patients with intermediate or high risk PE?
Two DOACs are FDA-approved for early use (within 72 hrs), rivaroxaban and apixaban. The PEITHO-2 dabigatran cohort study included no comparison group (its authors called it a "trial"?) and required "72 hrs" parenteral anticoagulant before dabigatran but the small print in its Lancet Haematology show...
Under what circumstances, if any, would you wait on initiating a TKI for metastatic recurrence of a Stage III NSCLC which occurred while on consolidative durvalumab to minimize pneumonitis risk?
Hepatotoxicity is of greater concern with ALK/ROS1 inhibitors. ALK inhibitors such as crizotinib or alectinib in combination with anti-PD1/PD-L1 agents led to higher than expected rates of hepatic and/or dermatologic AEs (Spigel et al., PMID 29518553; Kim et al., PMID 35875467). The field has learne...
Would you offer a palliative or more aggressive course of radiation therapy for a symptomatic isolated supraclavicular recurrence of a squamous cell carcinoma of the esophagus?
Such early disease progression suggests there was likely occult involvement of the supraclavicular lymph node at the time of initial diagnosis. My decisions on management would hinge upon the extent of initial CRT field.If the supraclavicular lymph node was in field, I would favor a systemic treatme...
Would you recommend VIP x 4 cycles over EP x 4 cycles in a patient with good risk Stage IIIB seminoma but an elevated LDH over 5x upper limit of normal with a 20 pack year smoking history?
So I would not automatically rule out BEP X 3 just because he has a history of smoking. I would look at his age and renal function. If he is younger than 40-45 with good renal function and normal diffusion capacity, I would give him BEP X 3 and check him with each dose of bleo regarding the history ...
Given RADICALS-HD, are you completing 24 mo vs 6 mo of ADT with XRT following RP?
Initial: We know 2 years of ADT works. Adding to the classic RTOG 9601, RADICALS-HD demonstrated an improvement in the primary and clinically-relevant endpoint of MFS.Who should be offered 2 years is a more nuanced question. I rely heavily on the PSA to guide as I am influenced by the significant in...
Given the improved ability to spare heart, kidney and liver, should IMRT be the standard of care for gastric MALT lymphoma (despite the low dose needed to effectively treat these patients)?
Gastric MALT lymphoma is a tantalizing disease to utilize IMRT. The target is typically irregularly shaped and surrounded by critical normal structures, including the heart, liver, and kidneys. The standard dose for gastric MALT lymphoma is 30 Gy. Thus, one needs to be mindful of dose to all of thes...
For essential thrombocythemia with an indication for aspirin, would you defer therapy if they are on celecoxib?
For an individual with a diagnosis of ET and an indication for aspirin (81-100 mg PO daily), the concurrent use of the COX-2 inhibitor celecoxib would not lead me to hold aspirin. Available studies do not suggest that Celecoxib interferes with the antiplatelet effects of low-dose aspirin in a signif...
For essential thrombocythemia with an indication for aspirin, would you defer therapy if they are on celecoxib?
For an individual with a diagnosis of ET and an indication for aspirin (81-100 mg PO daily), the concurrent use of the COX-2 inhibitor celecoxib would not lead me to hold aspirin. Available studies do not suggest that Celecoxib interferes with the antiplatelet effects of low-dose aspirin in a signif...
Do you screen children with sickle cell disease for silent cerebral infarcts?
We screen children with sickle cell disease for SCIs at our center. This is because data suggest that silent cerebral infarcts (SCIs) are much more common than overt stroke and the long-term negative impacts of SCIs are significant. There are also treatments (e.g., chronic transfusion and stem cell ...
Is there therapeutic relevance for FLT3-ITD mutation in relapsed APML?
FLT3-ITD mutations are seen in anywhere from 12-38% of APL cases, and there are conflicting data on the prognostic impact of the mutation on outcomes (Kuchenbauer et al., PMID 16029447, Beitinjaneh et al., PMID 20096459, Kiyoi et al., PMID 9305596, Kainz et al., PMID 12522450, Schnittger et al., PMI...