Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
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...
What are your top takeaways in Hematology from ASCO 2025?
I would say: CARTITUDE-1 updates – first time we are seeing a plateau in a MM trial, that too in the relapsed/refractory setting with 5+ years follow-up. JNJ-5322 Trispecific – dual antigen targeting with less frequent dosing; 100% response rate in BCMA/GPRC5D naïve relapsed/ref MM patients; safety...
What are your top takeaways in Hematology from ASCO 2025?
I would say: CARTITUDE-1 updates – first time we are seeing a plateau in a MM trial, that too in the relapsed/refractory setting with 5+ years follow-up. JNJ-5322 Trispecific – dual antigen targeting with less frequent dosing; 100% response rate in BCMA/GPRC5D naïve relapsed/ref MM patients; safety...
When would you treat mild anemia from low testosterone in an older male?
The primary indication for testosterone treatment is symptomatic hypogonadism and not anemia. Given the risk for adverse events in terms of erythrocytosis, cardiovascular events, and potential prostate diseases, the risk of providing testosterone for asymptomatic, mild anemia outweighs its benefits,...
What is your approach to an infant (<12 mo) with new onset petechiae and thrombocytopenia, with labs consistent with ITP?
In an older (1-6 year old) child with apparent ITP, less work up might be needed. While many tests are possible, in this case, labs consistent with ITP, I would interpret as including a CBC otherwise normal for age without blasts on a smear (if this is not true, the differential is much wider). If i...