Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Would you recommend surgery or stereotactic radiation therapy for a young woman with high-grade serous ovarian cancer presenting with a pelvic LN oligometastasis following maintenance therapy?
Like OM, the principle for other cancer favors SBRT as has excellent local control and low morbidity Donovan et al., PMID 38869888
Would you include midostaurin in induction and consolidation for patients with good-risk AML with NPM1 mutation and FLT3-ITD (<0.5)?
Yes, in my practice I routinely include FLT3 inhibitor (midostaurin) in upfront 7 plus 3 chemotherapy for all younger fit patients with AML regardless of NPM1 status or FLT3 allelic ratio. The RATIFY trial validated the benefit of midostaurin in patients regardless of ITD allelic birder (both high a...
Would you include midostaurin in induction and consolidation for patients with good-risk AML with NPM1 mutation and FLT3-ITD (<0.5)?
Yes, in my practice I routinely include FLT3 inhibitor (midostaurin) in upfront 7 plus 3 chemotherapy for all younger fit patients with AML regardless of NPM1 status or FLT3 allelic ratio. The RATIFY trial validated the benefit of midostaurin in patients regardless of ITD allelic birder (both high a...
In which clinical settings do you use the Cerianna (fluoroestradiol F18) PET scan for breast cancer?
The established clinical utility of FES PET in guidelines is to detect the presence of ER+ metastatic disease in instances where a biopsy is inconclusive, difficult, or not possible. Some other scenarios where FES PET may be useful include: Decalcified bone lesion biopsies where ER IHC may be falsel...
How do you approach early-stage breast cancer patients who are asking for ctDNA or tumor marker surveillance (or previously receiving these with another provider) when these are not part of the NCCN or ASCO guidelines?
In regards to tumor markers, I admit that I follow these in some of my higher-risk (high-risk stage IIB-IIII) patients, despite ASCO and Choosing Wisely guidelines not to do so but am not willing to send these in lower-risk (stage I-IIA) patients, even if they request that I do so, explaining that i...
Do you routinely utilize G-CSF as primary prophylaxis in patients receiving mFOLFIRINOX or FOLFOXIRI?
Interesting to see the differences. I can't speak for others in our large GI practice but as we see well over 1000 pancreas cancer patients/year, there is substantial experience with FFX. I personally do not use primary prophylaxis and I/we do not routinely check DPYD. If neutropenia occurs, we add ...
What is your preferred sequencing of adjuvant chemotherapy and PMRT for node + breast cancer?
I addressed this issue for patients treated with breast-conserving surgery in May 2023; please see that answer for more details. To summarize, the toxicities from chemotherapy may be greater and its effectiveness reduced (at least for high-risk patients) when given after RT instead of before (Recht ...
How would you treat progressive Rosai Dorfman Destombes disease after initial limited radiation therapy?
To provide the best answer, we need a little more detail on this case. Also, is the patient symptomatic from the abdominal disease? If not, I would observe in the short term. If symptomatic, I would do PET/CT and consider a repeat biopsy, given the risk of the development of another process. Do you ...
How would you treat progressive Rosai Dorfman Destombes disease after initial limited radiation therapy?
To provide the best answer, we need a little more detail on this case. Also, is the patient symptomatic from the abdominal disease? If not, I would observe in the short term. If symptomatic, I would do PET/CT and consider a repeat biopsy, given the risk of the development of another process. Do you ...
How do you approach continuing vs discontinuing ovarian suppression for high risk HR+ breast cancer when a patient becomes post-menopausal?
I'm assuming this is a woman in her late 40's or preferably over 50 (I wouldn't trust that a younger woman was permanently postmenopausal no matter what the clinical and lab picture is). It can be challenging to determine that a patient on ovarian function suppression (OFS) is actually post-menopaus...