Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How do differences in toxicity profile factor into your choice between a T-DXd-based neoadjuvant regimen and ddAC-THP?
The standard-of-care arm does not reflect my typical practice for this patient population. I almost always treat with neoadjuvant TCHP, so patients are usually spared anthracyclines. That being said, the real risk of ILD requires that we appropriately select the patients who receive T-DXd-THP. Speci...
How would the updated results of ECOG 3311 influence your adjuvant RT recommendations for HPV+ OPSCC?
This question refers to this manuscript (Burtness et al., PMID 40493877), which is a 4.5-year follow-up of ECOG E3311.The results broadly mirror those seen in previous reports. The most notable novel finding reported is that among patients with low-risk features (who did not get any adjuvant RT), th...
What tips do you provide patients on therapeutic LMWH who have difficulty with injections and are bothered by bruising?
I counsel patients that injection site bruising is extremely common and should be expected. To try to limit the impact, they should make sure they are avoiding injection into the superficial blood vessels on either side of the abdomen. Sometimes moving to thighs or upper arms can help. If injections...
What tips do you provide patients on therapeutic LMWH who have difficulty with injections and are bothered by bruising?
I counsel patients that injection site bruising is extremely common and should be expected. To try to limit the impact, they should make sure they are avoiding injection into the superficial blood vessels on either side of the abdomen. Sometimes moving to thighs or upper arms can help. If injections...
When, if ever, would you recommend risk reducing BSO in patients with moderate penetrance breast cancer germline mutations?
RAD51C, RAD51D, and BRIP1 are all associated with significant risks of ovarian cancer and are appropriate for consideration of prophylactic oophorectomy, albeit perhaps at a slightly later age than BRCA1 and BRCA2. ATM and PALB2 may be associated with ovarian cancer risks that are similar to that of...
How would you manage a patient less than 40 years old with an incidentally found LGG, IDH mutated, 1p19q intact, s/p STR?
Update: On August 6, 2024, the FDA approved Vorasidenib for IDH-mutant low-grade gliomas based on findings from the INDIGO trial. This decision highlights the FDA's incompetence and lack of scientific integrity, clearly demonstrating that the agency prioritizes pharmaceutical companies' interests ov...
Would you consider adding gabapentin off label for use in the treatment of glioblastoma at this time?
As an author on the paper, let me emphasize the findings and speculate on the implications. Recently, a number of laboratories have unraveled stunning preclinical and mechanistic findings demonstrating the ability of a subset of malignant glioma cells to usurp neuronal circuitry to promote tumor gro...
What experience do you have with paralysis or myasthenia-like symptoms developing on temozolomide?
I have not had a patient with this adverse effect. Mechanistically, I am not sure how this would be explained by the drug. I would recommend a workup for other contributing factors. I was unable to find any reports in the literature of TMZ-induced MG.
How do you approach the use of teclistamab plus daratumumab in patients with relapsed/refractory multiple myeloma who have previously been exposed to daratumumab or isatuximab?
If the last exposure to daratumumab or isatuximab was at least 6 months prior to relapse (CD38- exposed but not refractory), I would give consideration to a combination of teclistamab and daratumumab for the relapsed disease. If patients are actively progressing while on daratumumab or isatuximab th...
How do you approach the use of teclistamab plus daratumumab in patients with relapsed/refractory multiple myeloma who have previously been exposed to daratumumab or isatuximab?
If the last exposure to daratumumab or isatuximab was at least 6 months prior to relapse (CD38- exposed but not refractory), I would give consideration to a combination of teclistamab and daratumumab for the relapsed disease. If patients are actively progressing while on daratumumab or isatuximab th...