Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
When, if ever, would you select a three-drug regimen instead of four-drug regimen in patients with newly diagnosed Multiple Myeloma?
Thank you for this question. For older, transplant-ineligible patients, there is no data that patients live longer or better (the true goals of treatment) with four drugs instead of three drugs. Yes, the responses are better, and we hope this may translate to longevity over time, but we do not know ...
When, if ever, would you select a three-drug regimen instead of four-drug regimen in patients with newly diagnosed Multiple Myeloma?
Thank you for this question. For older, transplant-ineligible patients, there is no data that patients live longer or better (the true goals of treatment) with four drugs instead of three drugs. Yes, the responses are better, and we hope this may translate to longevity over time, but we do not know ...
In what situation would you recommend ipilimumab + nivolumab over relatlimab + nivolumab in the treatment of metastatic melanoma?
There is no clinical trial to provide a direct comparison between the two regimens, hence the answer to this question is usually driven by personal interpretation of the data and patient preference. The data for both regimens show a statistically significant PFS benefit and a superior response rate ...
Does a very high Oncotype score influence your approach to adjuvant treatment in a patient with ER positive breast cancer?
This is a very intriguing question that has a simple answer. There is no data on choice or aggressiveness of chemotherapy and resulting benefit in patients with higher oncotype recurrence score. What regimen to use remains a judgement call, but for most patients with ER+/node negative tumors with a ...
How do you counsel patients about the likelihood of improvement in kidney disease after anti-cancer treatment is initiated in a patient with malignancy associated membranous nephropathy?
There are numerous case reports to support that if the patient has a paraneoplastic MN then the expectation is that the renal lesion will respond to cancer directed therapy.
What is the appropriate concurrent chemoradiation regimen to treat unresectable stage IIB lung adenocarcinoma?
Historically, many locally advanced NSCLC trials have included patients with unresectable stage II disease. While those patients comprised only a few % of the study population, I think it is largely reasonable to extrapolate findings from stage III NSCLC patients to patients with unresectable stage ...
For stage III NSCLC treated with definitive intent chemoRT, how do you decide to proceed with surgery vs consolidation immunotherapy?
When we initially evaluate a patient with locally advanced NSCLC, we make the decision upfront about whether the patient will be managed surgically or not, and then we stick to that plan as long as everything proceeds as expected. So someone treated with definitive intent would get durvalumab (shown...
What is your preferred next line of therapy for a fit patient with unresectable, refractory osteosarcoma who has progressed after MAP, local radiation, and IE?
Regorafenib is fine to try. Pazopanib has activity too. I give more pazopanib than regorafenib, so I usually reach for pazopanib first. If your patient progressed right through MAP then there is no reason to go back. But if your patient had primary MAP and now, some time later, has progression, yo...
What would be your preferred anticoagulant for recurrent DVT/PE in a patient on hemodialysis with calciphylaxis and prior DOAC failure?
A truly complex case: recurrent DVT/PE in the setting of ongoing risk factors for both VTE (active calciphylaxis, prior DOAC failure, and obesity) and bleeding (ESRD on hemodialysis), each of which constrains a different anticoagulant option. Given the complexity and rarity of this case, recommendat...
Are there data to support full-dose anticoagulation added to an antiplatelet in recurrent peripheral arterial thrombosis requiring revascularization and stenting?
This question comes up frequently at our institution. I previously consulted with our vascular surgery team who referred me to this trial of Edoxaban with SAPT, trying to avert what may be limb loss if the bypass graft/stent fails. We've often promoted rivaroxaban 2.5 mg po BID per VOYAGER PAD if we...