Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
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...
What is your preferred management for renal artery thrombosis causing renal infarct of unclear etiology?
This is a rare, under-recognized, and clinically challenging situation that has been debated for years, primarily because it falls within an evidence “gray-zone.” When evidence is lacking, opinions are abundant, and practice variations are substantial. In general, it is crucial to distinguish betwee...
What are your top takeaways in Thoracic Cancers from ASCO 2024?
ADRIATIC – The addition of consolidation durvalumab after chemo/RT for people with limited-stage SCLC resulted in a 10% improvement in 3-year overall survival, which hopefully means an equivalent improvement in cure rate. Importantly, unlike many trials that are now presented way too early, this on...
Based on the results of CALGB 80803, would you consider induction and/or concurrent FOLFOX in neoadjuvant treatment of esophageal adenocarcinoma?
Great question. The CROSS regimen has been our standard for resectable GE junction and esophagus adenocarcinomas, but the data from the CALGB 80803 study are compelling.For some patients with questionable disease resectability, usually due to extensive nodal involvement, we have been giving “inducti...
How do you approach the discussion and decision-making regarding surgery vs SBRT for stage I NSCLC in patients who are candidates for both?
I agree with Dr. @Dr. First Last that it requires a very nuanced and personalized discussion. Our Yale approach (led by Frank Detterbeck) has been detailed in a 4-paper series in the Journal of Thoracic Disease 2022 (overview and SBRT/ablation focus), with the general paradigm balancing short-term, ...
Given the data from SWOG 1826 suggesting that Nivo-AVD is likely the preferred regimen for advanced Hodgkin lymphoma patients, are there scenarios where alternative regimens may still be preferred?
Unless there was a contradiction to nivolumab (e.g., an active autoimmune disease), I would always favor N-AVD over BV-AVD- particularly in older patients.
Given the data from SWOG 1826 suggesting that Nivo-AVD is likely the preferred regimen for advanced Hodgkin lymphoma patients, are there scenarios where alternative regimens may still be preferred?
Unless there was a contradiction to nivolumab (e.g., an active autoimmune disease), I would always favor N-AVD over BV-AVD- particularly in older patients.
What is the role for adjuvant chemotherapy and/or radiation in ampullary carcinoma?
Such a challenging question because of a paucity of good data. When I try to decide what to do in this setting, a lot of it depends upon the patient's clinical factors (ability to tolerate therapy, postoperative recovery, margin status, etc). Based on ESPAC-3, I felt pretty comfortable that for most...
Do you omit consolidative RT in pediatric patients with intermediate risk, non-bulky Hodgkin lymphoma who have a rapid early response to chemotherapy?
Yes, if the patients meet the rigid requirements for response, which include a rapid early response (Complete response or very good partial response) after 2 cycles of ABVE-PC chemotherapy AND have a complete response at the end of treatment then the data suggests similar outcomes whether or not the...
Have you seen CD30+ lymphoproliferative skin lesions with Upadacitinib treatment of atopic dermatitis?
I have seen this occur in the setting of atopic dermatitis in one instance with a patient on dupilumab who developed head and neck CD30+ disease. It is certainly possible with upadacitinib but I think most if not all cases of CTCL in the setting of AD were always CTCL from the beginning and just mis...