Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Does the use of A+AVD versus ABVD affect your decision for consolidation RT for bulky Hodgkin lymphoma?
A+AVD is an acceptable regimen for advanced HL based on results from the ECHELON-1 study (Ansell et al., PMID 35830649) showing an improvement in both PFS (82% vs 75% at 6 years) and OS (94% vs 89%) compared with ABVD. Radiation therapy was not incorporated into this study.In advanced HL, regardless...
For a patient post-prostatectomy with a high PSA (>1), a negative MRI pelvis, and a negative PSMA PET scan, do you pursue any other imaging?
The sensitivity of PSMA scan for PSA above 1 is about 75-90%. I would proceed with salvage RT plus ADT like we did in the era when PSMA was not available.
Do you routinely start anticoagulation for a patient with newly diagnosed hepatocellular carcinoma presenting with a portal venous thrombosis?
No. Anti-coagulation is generally not indicated. Anti-coagulation is usually only indicated for acute PVT causing symptoms. This is more common with underlying thrombophilia. PVT is very common in cirrhosis and anti-coagulation is not required. PV thrombus from tumor similarly is common and anti-coa...
Do you routinely start anticoagulation for a patient with newly diagnosed hepatocellular carcinoma presenting with a portal venous thrombosis?
No. Anti-coagulation is generally not indicated. Anti-coagulation is usually only indicated for acute PVT causing symptoms. This is more common with underlying thrombophilia. PVT is very common in cirrhosis and anti-coagulation is not required. PV thrombus from tumor similarly is common and anti-coa...
Do you offer prostate RT to men with 0-3 bone metastases on conventional imaging when PSMA PET shows a very high number of M1 lesions?
This would be a hard no from my standpoint.I get the rationale here. STAMPEDE found a survival benefit for prostate-directed RT in men with "low volume" disease, which was defined based on the CHAARTED trial with conventional imaging. Therefore, men with low-volume disease on conventional imaging fi...
How do you approach conversations regarding discontinuation of transfusions in patients with advanced hematologic malignancies who are otherwise appropriate for hospice?
While not an expert in leukemia care or MDS, the answer is nuanced (both in the care of patients and to hospice agencies). Some hospice programs will make exceptions to blood transfusions depending on how frequent - so it is always good to ask. From a clinical perspective, important to consider whet...
How do you approach conversations regarding discontinuation of transfusions in patients with advanced hematologic malignancies who are otherwise appropriate for hospice?
While not an expert in leukemia care or MDS, the answer is nuanced (both in the care of patients and to hospice agencies). Some hospice programs will make exceptions to blood transfusions depending on how frequent - so it is always good to ask. From a clinical perspective, important to consider whet...
What would you recommend for a stage I diffuse large B cell lymphoma (IPI 0-1) involving a single lymph node that is completely removed with an excisional biopsy?
Some more info woud be helpful such as age of pt, size and location of node, margins of resection. In general 6 cycles of RCHOP is prefered with RT in almost all instances. 3 cycles is reserved for the most favorable patients. I would add ISRT adhering to recent guidelines from Intl Lymphoma Radiati...
Is it appropriate to re-consider bladder preservation in patients with bladder muscle-invasive cancer (T2) who were initially poor candidates for BP (multifocal disease, etc.) but had complete response after neoadjuvant chemotherapy?
It is perfectly appropriate. There are many ways to achieve a complete response to T2 bladder cancer. It can be reached with radiation, an aggressive local resection, or chemotherapy. The issue is whether or not it is durable. None of these therapies alone have a great track record, although chemoth...
What is your surveillance approach for outpatient monitoring of ICI myocarditis?
Screening and surveillance strategies for outpatient monitoring of ICI myocarditis are not well-defined. The best surveillance approach would be based on clinical risk assessment, followed by biomarker and imaging data. The risk factors for ICI myocarditis remain to be clarified, but the most valida...