Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How do you manage steroid-refractory immune checkpoint inhibitor induced pneumonitis?
Steroid-refractory immune checkpoint inhibitor (ICI)-induced pneumonitis is managed with high-dose steroids plus an additional immunosuppressive agent, like infliximab or intravenous immunoglobulin (IVIG) among others. I recommend early immunomodulatory escalation as multiple studies have shown that...
How do you approach the workup of subcentimeter contralateral nodules in cases of locally advanced NSCLC?
These are often challenging questions/issues in our multimodality discussions. A couple of "general" principles/considerations. I would try, if at all possible to prove the presence of metastatic disease, however in the case of sub cm contralateral nodules, this is, as the question alludes to, not a...
What is the risk of local recurrence in a high grade muscle invasive bladder cancer (MIBC) s/p incomplete TURBT treated with concurrent chemoradiation compared to a complete TURBT?
One source I’m aware of that could shed light on this specific question is a 2017 publication from MGH (Giacalone et al., PMID 28081860), reporting the outcomes of 475 patients with T2-4a N0 M0 bladder cancer treated with various protocols from 1986-2013. Not all patients had high-grade tumors, but ...
How would you manage a pre-menopausal woman with extranodal marginal zone lymphoma confined to the bladder wall?
Marginal Zone Lymphoma (MZL) when localized is curable in most instances with modest doses of RT (24-30 Gy), perhaps even less when the primary site is the orbit. It typically responds to rituximab but relapses occur in most cases. Therefore, definitive RT is the treatment of choice in the great maj...
How would you manage a pre-menopausal woman with extranodal marginal zone lymphoma confined to the bladder wall?
Marginal Zone Lymphoma (MZL) when localized is curable in most instances with modest doses of RT (24-30 Gy), perhaps even less when the primary site is the orbit. It typically responds to rituximab but relapses occur in most cases. Therefore, definitive RT is the treatment of choice in the great maj...
For primary MZL of the breast, do you do whole breast to 24 Gy or ISRT?
Without knowledge of the age of this patient and whether the concern of carcinogenicity from half the normal dose of traditional whole breast radiation (which we obviously do all the time for breast cancer) is enough to warrant omission of curative intent therapy in what is otherwise described as a ...
How do you treat metastatic squamous cell carcinoma of the bladder?
No good data, we tend to use either gemcitabine/cisplatin or 5FU or taxane based therapy. Ideally clinical trials. Recent data that we published showed underlying biology and retrospective experience amenable to checkpoint inhibitor, which can be tried, esp. after PD on chemoTx.
How do you treat muscle-invasive and metastatic sarcomatoid bladder cancer?
This is a very challenging disease with poor prognosis and low response rate to therapy. If it's predominant or pure sarcomatoid, we are opening a neoadjuvant clinical trial with dose dense MVAC plus pembrolizumab before surgery. If there is no trial, I would do upfront radical cystectomy and PLND f...
Is there a role to continue aspirin in patients with myeloproliferative disorders who have never had a thrombotic event that are starting DOAC for stroke prophylaxis with newly diagnosed atrial fibrillation?
Aside from treating erythromelalgia, transient ischemic attacks (TIA) such as ocular migraine or documented atherosclerotic disease, aspirin has no role in the management of the MPN, despite the widely published recommendations for its use, particularly in so-called "high risk" polycythemia vera (PV...
Is there a role to continue aspirin in patients with myeloproliferative disorders who have never had a thrombotic event that are starting DOAC for stroke prophylaxis with newly diagnosed atrial fibrillation?
Aside from treating erythromelalgia, transient ischemic attacks (TIA) such as ocular migraine or documented atherosclerotic disease, aspirin has no role in the management of the MPN, despite the widely published recommendations for its use, particularly in so-called "high risk" polycythemia vera (PV...