Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How would you manage presumed gestational thrombocytopenia with moderate thrombocytopenia for delivery planning?
Thanks for this question. First and foremost, it's critical to rule out a placental-mediated complication such as pre-eclampsia and HELLP, and to evaluate for other more nefarious causes of thrombocytopenia (TTP, aHUS, etc., though of course rare). While a diagnosis of exclusion, gestational thrombo...
Do you routinely use chemo cold caps?
The decision to use cold caps is very personal (one must consider financial implications, associated time commitment, personal feelings about alopecia etc.) and so I provide information to patients but I don't counsel them in any specific direction. Cold caps appear to be most effective for women re...
Do you add a platinum agent to neoadjuvant chemotherapy for triple negative breast cancer in BRCA 1/2 mutation carriers?
Several studies in the metastatic setting (e.g. the TNT trial) have suggested an improved response and progression free survival with platinums in BRCA –mutant breast cancer. In the neoadjuvant setting, a study of 107 women with breast cancer and BRCA1 mutation, treated with 4 cycles of cisplatin, h...
Can anti-cardiolipin or anti-beta-2 glycoprotein antibodies cause prolonged PTT in the absence of a lupus anticoagulant?
Lupus anticoagulants are a heterogeneous group of antibodies that do not have uniform activity in all assays. Furthermore, testing procedures are not well-standardized. Since relevant clotting factor deficiencies have been ruled out and the long PTT does not correct with mixing, and since there is o...
Given potential long-term CV toxicity concerns with lorlatinib and data suggesting that dose reduction does not compromise efficacy, do you ever recommend initiating and/or maintaining lower-dose lorlatinib in ALK+ NSCLC?
It depends. I'm a firm believer in the maximum dose a patient can tolerate and do well on with minimal side effects and maintain a strong quality of life as they live with this for a long time. For an older patient, I would start at 75 mg but for young, I would start at 100 and a low threshold to re...
Do you offer systemic therapy for NSCLC (no driver mutation) after resection of a metachronous solitary brain metastasis occuring after definitive therapy for limited disease, with no evidence of active extracranial disease?
I'm not sure that I have any definitive evidence to present regarding this (ie no trial data), speaking primarily from experience and bias. As I take it, the patient presented in the question is now surgically NED and has had appropriate treatment of his isolated metastatic site of disease with no k...
How do you approach melanoma patients with a positive sentinel node with extra-nodal extension for definitive surgical management?
This is a multidisciplinary question so I reached out to our surgical oncologist (Dr. @Dr. First Last) at the Ohio State University Comprehensive Cancer Center for his thoughts as well. This is a grey area as the patients with extra-nodal extension (ENE) were not specifically studied in the landmark...
How do you do risk stratification for patients with light-chain-only MGUS?
This is a great question, Dr. @Dr. First Last. Apologies for the delay in responding.Light-chain disease is not as clearly defined as heavy-chain disease.There is some guidance here based on current studies, such as Maeng et al., PMID 40295472, revised free light chain reference intervals enhance ri...
What is your preferred treatment option after tarlatamab for patients with ES-SCLC?
The preferred treatment is a clinical trial - and there are several promising agents in development for SCLC, including a number of antibody-drug conjugates targeting B7-H3, Trop2, SEZ6, and DLL3. Outside of a trial, our treatment algorithms focus on chemotherapy, and my preferred agent here is lurb...
What initial systemic therapy would you offer a patient with metastatic colon cancer with BRAF V600E mutation, MSS, who is not an oxaliplatin candidate?
In patients with BRAF-V600E mutant colon cancer who are not candidates for oxaliplatin, replacing the chemo backbone with FOLFIRI is what I’ve done for a few patients without any clinical or insurance issues.This is based on the BREAKWATER study, which, of note, had a FOLFIRI/EC arm - results report...