Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Is a tumor ever too small to send off a genomic assay like Oncotype or Mammoprint in HR positive, HER2 negative stage 1 breast cancer?
The Oncotype DX has been used to identify high risk stage T1b tumors that may benefit from the addition of chemotherapy such as Taxotere/Cytoxan for 4 cycles and has been part of NCCN guidelines for quite some time. We do consider chemotherapy for high risk T1b luminal B tumors (either on basis of h...
How do you interpret elevations in ESR and CRP in the setting of increased BMI?
Increases in BMI (overweight and obesity range) have been shown to be associated with elevated CRP and ESR, with stronger associations shown with CRP specifically. Interestingly, the association between elevated CRP and obesity seems to be stronger in female populations than in male patients.In the ...
How do you interpret elevations in ESR and CRP in the setting of increased BMI?
Increases in BMI (overweight and obesity range) have been shown to be associated with elevated CRP and ESR, with stronger associations shown with CRP specifically. Interestingly, the association between elevated CRP and obesity seems to be stronger in female populations than in male patients.In the ...
How should one monitor for and manage CMV reactivation in patients receiving alemtuzumab?
Here's how I approach it: Baseline Testing: Perform CMV serology (IgG/IgM) and quantitative CMV DNA PCR before initiating alemtuzumab to establish baseline status. Frequency: Weekly PCR testing for 8–12 weeks post-infusion, focusing on the high-risk window (weeks 3–6). Extend monitoring ...
How do you counsel patients with Stage IIIA EGFR+ lung cancer regarding treatment intent with concurrent chemoRT + consolidative systemic therapy?
I think one of the crucial take-home points from the LAURA clinical trial (Lu et al., PMID 38828946) is how often we (the medical oncology community) tell patients we are treating them with "curative intent" but ignore the incredibly high relapse risk among patients with EGFR mutant NSCLC with stage...
What are your top takeaways in Breast Cancer from ASCO 2024?
1. DESTINY-Breast06 This phase 3 trial randomized patients to either Trastuzumab deruxtecan (T-DXd) vs. physician’s choice chemotherapy (capecitabine, nab-paclitaxel, paclitaxel) in hormone receptor positive HER2 low or HER2 ultralow (any membrane staining) metastatic breast cancer after prior endoc...
Are there specific findings that would make you suspicious of IgD or IgE monoclonal gammopathies?
I mostly consider an IgD or IgE monoclonal gammopathy in a patient who has a measurable serum M-spike on serum protein electrophoresis but a serum immunofixation that only shows a light chain band (either kappa or lambda). Since patients with light chain-only myeloma usually have at most a tiny mono...
What systemic therapy would you recommend for a patient with metastatic triple negative breast cancer (HER2 1+) who has progression of brain mets after WBRT and while receiving first line chemotherapy?
There is early evidence of untreated intracranial metastasis activity (overall response rate 73%; 11/15 patients) with trastuzumab deruxtecan (T-DXd) in patients with HER2+ breast cancer (1), but such data are not yet available for HER2-low breast cancer. Therefore, I would advocate a standard appro...
How do you approach the management of patients with locally advanced unresectable mucosal melanoma in the head and neck region?
I start them either on ipi (3 mg/kg)/nivo (1 mg/kg) or a clinical trial with similar immunotherapy drugs. Indeed, I had 2 such cases yesterday in the clinic who have at least a partial remission. If feasible, a new biopsy should be done after about 4 cycles to look for viable cancer. If there is a g...
How long would you anticoagulate for PE developed after air travel in a woman on an estrogen-containing vaginal ring for contraception?
This patient has two transient (“provoking”) factors that may have contributed to her pulmonary embolism (PE): the use of estrogen-containing contraception and, presumably, a recent long-haul air travel. Traditionally, it has been assumed that, after three months of treatment for the initial venous ...