Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Is there still a role for plasma exchange/PLEX for confirmed or suspected cast nephropathy in multiple myeloma to rapidly reduce light chain burden?
This is a good question that comes up from time to time. The most important thing is time-to-bortezomib, which should be as short as possible.For light chain only disease, I do not do plasma exchange. My reasons are: It only marginally reduces free light chains (see: Hutchison et al., PMID 17229909)...
Which BRAF/MEK inhibitor combination have you found most tolerable and easiest to prescribe in good performance patients with mutated metastatic melanoma?
I prefer using encorafenib and binimetinib. Although the number of pills is many (almost 12 a day), the most common toxicity I have encountered is GI toxicity of nausea and vomiting followed by occasional diarrhea. One patient, in my entire experience of six years of treating melanoma, reported feve...
How would you approach treatment in an older (>65), but fit patient with intermediate-risk AML, but with MRD persistence after induction with 7+3?
The presence of measurable or minimal residual disease (MRD) after induction chemotherapy, before allogeneic transplant or after transplant is associated with risk of relapse. (Araki et al. J Clin Oncol. 34:329-36) The detection and measurement of MRD by flow cytometry requires specific expertise in...
How would you approach treatment in an older (>65), but fit patient with intermediate-risk AML, but with MRD persistence after induction with 7+3?
The presence of measurable or minimal residual disease (MRD) after induction chemotherapy, before allogeneic transplant or after transplant is associated with risk of relapse. (Araki et al. J Clin Oncol. 34:329-36) The detection and measurement of MRD by flow cytometry requires specific expertise in...
Do you use Oncotype to predict chemo benefit on all localized HR+ patients per TAILORx criteria or do you use your judgement and skip it in T1b-c grade 1 or grade 2 tumors?
Oncotype is not always needed, for example in grade 1, small tumors as suggested. As a reminder, still, most ER positive tumors are endocrine sensitive and only a minority will be higher risk, endocrine resistant tumors. The biggest contribution for Oncotype has been to spare the many patients with...
For patients with VEXAS syndrome and good response to azacitidine, what duration of therapy do you consider?
The short answer: as long as azacitidine is controlling inflammation, reducing/eliminating steroid dependence, and/or improving cytopenias, keep using it. Don't stop (or if the patient is being bridged to alloSCT, continue until BMT).The long answer:VEXAS is an autoinflammatory disease wherein patie...
For patients with VEXAS syndrome and good response to azacitidine, what duration of therapy do you consider?
The short answer: as long as azacitidine is controlling inflammation, reducing/eliminating steroid dependence, and/or improving cytopenias, keep using it. Don't stop (or if the patient is being bridged to alloSCT, continue until BMT).The long answer:VEXAS is an autoinflammatory disease wherein patie...
Do you routinely check hormone levels to confirm postmenopausal status before adding aromatase inhibitors to OFS in premenopausal women with early breast cancer?
I avoid the issue by taking a sequential approach. I typically start premenopausal women on tamoxifen, then add OFS 4-6w later depending on their tolerance of tamoxifen, and then change to an AI after another 6-12 weeks. It is easy to underestimate the severity of side effects that many premenopausa...
How would you treat a BRAF WT metastatic melanoma patient with leptomeningeal disease in the frontline setting?
LMD from melanoma carries a dismal prognosis (weeks to a few months of survival), depending on how symptomatic the patient is from the increased intracranial pressure. Please refer to a case report I published a while ago with Dr. Ahmad Tarhini from Moffitt Cancer Institute for a discussion of this ...
What are your top takeaways from SGO 2025?
Results from the NRG Oncology GOG-0263 phase III clinical trial testing the addition of cisplatin-based chemotherapy to adjuvant radiotherapy following radical hysterectomy for patients with early-stage, intermediate-risk cervical carcinoma indicated that the addition of chemotherapy did not improve...