Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How do you approach the discussion and decision-making regarding surgery vs SBRT for stage I NSCLC in patients who are candidates for both?
I agree with Dr. @Dr. First Last that it requires a very nuanced and personalized discussion. Our Yale approach (led by Frank Detterbeck) has been detailed in a 4-paper series in the Journal of Thoracic Disease 2022 (overview and SBRT/ablation focus), with the general paradigm balancing short-term, ...
Given the data from SWOG 1826 suggesting that Nivo-AVD is likely the preferred regimen for advanced Hodgkin lymphoma patients, are there scenarios where alternative regimens may still be preferred?
Unless there was a contradiction to nivolumab (e.g., an active autoimmune disease), I would always favor N-AVD over BV-AVD- particularly in older patients.
Given the data from SWOG 1826 suggesting that Nivo-AVD is likely the preferred regimen for advanced Hodgkin lymphoma patients, are there scenarios where alternative regimens may still be preferred?
Unless there was a contradiction to nivolumab (e.g., an active autoimmune disease), I would always favor N-AVD over BV-AVD- particularly in older patients.
What is the role for adjuvant chemotherapy and/or radiation in ampullary carcinoma?
Such a challenging question because of a paucity of good data. When I try to decide what to do in this setting, a lot of it depends upon the patient's clinical factors (ability to tolerate therapy, postoperative recovery, margin status, etc). Based on ESPAC-3, I felt pretty comfortable that for most...
Do you omit consolidative RT in pediatric patients with intermediate risk, non-bulky Hodgkin lymphoma who have a rapid early response to chemotherapy?
Yes, if the patients meet the rigid requirements for response, which include a rapid early response (Complete response or very good partial response) after 2 cycles of ABVE-PC chemotherapy AND have a complete response at the end of treatment then the data suggests similar outcomes whether or not the...
Have you seen CD30+ lymphoproliferative skin lesions with Upadacitinib treatment of atopic dermatitis?
I have seen this occur in the setting of atopic dermatitis in one instance with a patient on dupilumab who developed head and neck CD30+ disease. It is certainly possible with upadacitinib but I think most if not all cases of CTCL in the setting of AD were always CTCL from the beginning and just mis...
In what clinical situations do you order NavDx?
At MSKCC, we largely use NavDx as part of our post-operative de-escalation trial in which NavDx is checked pre and post surgery to help select patients for de-escalation. If NavDx becomes undetectable after surgery: In patients with pathologic risk factors that warrant adjuvant RT, patients undergo...
In massive transfusion protocol from suspected hemorrhage, is it worth obtaining a TEG to guide transfusion?
There really is no evidence (except expert opinion) on massive transfusion protocols and outcomes. There are a few trials showing that TEG or other viscoelastic tests reduce transfusion and even improve survival or other important outcomes in hemorrhage. So given the choice, if rapid point of care T...
How would you manage a POLE mutated, p53 abnormal IA myoinvasive carcinosarcoma of the endometrium with no LVSI?
I would not change the management of IB and above non-endometrioid histology based on mutation analysis as almost all data is for endometrioid histology.
How would you treat a patient with history of stage I seminoma s/p orchiectomy with enlarging periaortic node and normal tumor markers on surveillance?
With respect to working up the enlarging lymph node, I agree with @Dr. First Last and @Dr. First Last above. If confident that this is seminoma recurrence, tumor markers normal, and if stage IIA or select stage IIB (select non-bulky, <=3cm) cases, our team advocates for radiation to the para-aortic ...