Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How would you approach missed doses of fulvestrant due to COVID-19?
There is no specific guideline for this. But, as we do for patients who occasionally miss fulvestrant doses, I would try to schedule the next dose as soon as possible. Another option would be to consider an alternative endocrine therapy option such as AI, tamoxifen, which do not require for patients...
How do you counsel patients/families whose goals of care are clearly aligned with a comfort-focused, end-of-life approach, but who are hesitant to formally enroll in hospice?
Hospice sounds like a 4-letter word to a lot of families! I find it important to distinguish the philosophy of comfort care vs. the benefit package associated with enrolling in hospice. Some people are able to be provided end-of-life comfort care without electing the hospice benefit, and that is fin...
What scenarios, if any, are you delaying adjuvant chemotherapy in light of the COVID-19 outbreak?
This is a complex issue that our group here at MSKCC is dealing with right now, with formalized guidance pending. This is in mind of the fact that the mortality rate in Chinese patients with cancer approached 6%. While I wouldn't delay starting adjuvant therapy—which is being given with curative int...
Do you offer adjuvant radiation therapy for a breast cancer patient with dermatomyositis?
This is an exceptionally important question for clinicians. I'm a little biased as I run an autoimmune Myositis Clinic, but here are my two cents: Paraneoplastic dermatomyositis (DM) is a fairly common occurrence (roughly about 15% of all DM cases, but up to 30-40% in some subtypes, such as adult pa...
What is the role of adjuvant radiation in R0 node positive resected pancreatic adenocarcinoma in light of the recently presented RTOG 0848 abstract?
There are three options here in my practice. 1) Treat, 2) don't treat, and 3) "watch and wait, then ablate" (for a local recurrence). In general, I treat patients with CXRT who have positive margins (IMRT 45 Gy/25# to regional volume with SIB of 62.5 Gy to the margin. If it is an R2 resection (which...
How should you manage a coronavirus infected/suspected patient who is receiving radiotherapy and cannot interrupt or delay their cancer treatment?
Hi Everyone, I agree with all the comments—this is certainly a fluid situation. We have not had a confirmed COVID-19 case, but we have developed a plan. If it is deemed a known COVID-19 patient, and it is elected to continue treatment by the treating physician, the treatment will happen at the end o...
Should we be utilizing prophylactic G-CSF in our patients with intermediate risk of febrile neutropenia due to the COVID-19 pandemic?
There are many functions of G-CSF, including repression of T-cell and NK cell function. Unless you are certain that growth factors are not modifying the immune network to the detriment of viral clearance—there is no data that growth factors help clear viral infections.
Have your treatment recommendations for urothelial cancer patients changed given the ongoing COVID19 pandemic?
The therapeutic approach to cancer patients is changing rapidly due to the COVID-19 pandemic. In discussing with colleagues from several different countries, a few themes emerge. Patient visits, surgery, and treatment that is not essential is being deferred. The benefit/risk that we each consider fo...
Do you use bevacizumab in patients with history of VTE (DVT/PE) who are stable on anticoagulation?
I have used bevacizumab in many patients who are stable on therapeutic anticoagulation for prior VTE. If the first VTE occurs during treatment with bevacizumab, I hold the drug and then consider restarting it (if warranted by the clinical situation) after a period of stability on therapeutic anticoa...
Do you use bevacizumab in patients with history of VTE (DVT/PE) who are stable on anticoagulation?
I have used bevacizumab in many patients who are stable on therapeutic anticoagulation for prior VTE. If the first VTE occurs during treatment with bevacizumab, I hold the drug and then consider restarting it (if warranted by the clinical situation) after a period of stability on therapeutic anticoa...