Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Does high risk cytogenetics as a sole abnormality influence your treatment decision for smoldering multiple myeloma?
Several studies have looked at the prognostic factor of FISH abnormalities and risk of progression of SMM to active disease (Neben et al., 2013; Rajkumar et al., 2013). Deletion 17p and t(4;14) are associated with the highest risk of progression, with median time to progression of 24 months, as repo...
How can you adjust neoadjuvant or adjuvant platinum based chemotherapy for stage Stage II-III non-small cell lung cancer in patients with significant renal insufficiency?
This is a great question as to one of our key responsibilities as practicing oncologists. Properly tailoring treatment - in this example chemotherapy to our patient’s needs – recognizing particular co-morbidities of concern, his/her willingness to tolerate side effects, and striking the right balanc...
Would you recommend 1st line pembrolizumab for PD-L1 positive recurrent/metastatic cervical cancer patient who is not a candidate for or refuses chemotherapy?
No. First-line pembrolizumab has not yet been approved for that indication in cervical cancer. It is being studied in Keynote-826.
Do you perform PDL1 and molecular testing for patients with stages I-III NSCLC?
Do you order PDL1 and molecular testing for patients with stages I-III NSCLC?When I answered this question about two years ago, I said no, primarily because there was no Level 1 efficacy data to support an improvement in outcomes for these patients. This has since changed... although in some ways, n...
How do you treat a focal pericardial metastasis?
Both doable and appropriate in the selected patient. I have seen patients die of solitary progression of pericardial/myocardial metastasis that was ignored by their med onc (or, in the case I remember most vividly, their gyn onc) team because they assumed there wasn't a reasonable radiological optio...
In patients with advanced endometrial cancer who you plan to treat with chemotherapy + immunotherapy (per GY018 or RUBY), how and when do you utilize adjuvant EBRT and/or brachytherapy?
Reading the question at face value - does advanced endometrial cancer mean stage IVB? III/IVA? If IVB, there is not routinely a role of 'adjuvant' EBRT or BT.Given the discussion of adjuvant therapy, I presume the question is asking for the small fraction of RUBY and GY-018 patients who were stage I...
How do you approach a patient with IgM monoclonal gammopathy associated with severe neuropathy of unclear etiology?
I usually confirm if the patient does not have AL Amyloidosis or POEMS, and as part of work up for IgM MGUS, I order MYD 88 mutation. If all are negative and I still believe that neuropathy is caused from his/her MGUS, you can try IVIG for the neuropathy as a trial (of course after using gabapentin,...
How do you approach a patient with IgM monoclonal gammopathy associated with severe neuropathy of unclear etiology?
I usually confirm if the patient does not have AL Amyloidosis or POEMS, and as part of work up for IgM MGUS, I order MYD 88 mutation. If all are negative and I still believe that neuropathy is caused from his/her MGUS, you can try IVIG for the neuropathy as a trial (of course after using gabapentin,...
How do you approach DOAC dose reduction for secondary prophylaxis of VTE in cancer-associated thrombosis?
Data from the API-CAT trial (Mahé et al., PMID 40162636) show that de-escalation of apixaban after 6 months was non-inferior compared to the standard dose with respect to recurrent VTE. Although there was no difference in major bleeding, the lower dose of apixaban was superior from the clinically re...
How do you approach DOAC dose reduction for secondary prophylaxis of VTE in cancer-associated thrombosis?
Data from the API-CAT trial (Mahé et al., PMID 40162636) show that de-escalation of apixaban after 6 months was non-inferior compared to the standard dose with respect to recurrent VTE. Although there was no difference in major bleeding, the lower dose of apixaban was superior from the clinically re...