Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Do you offer adjuvant pembrolizumab post metachronous oligometastatic resection of RCC beyond the first year of diagnosis?
For patients with recurrence beyond 1 year of initial nephrectomy, I would not offer post metastasectomy pembrolizumab. Such patients would usually belong to the IMDC favorable risk category at the time of recurrence and could have a continued disease free interval post metastasectomy based on sever...
What is your preferred approach to low volume unresectable/metastatic favorable risk RCC?
For good-risk metastatic RCC patients, who are considered not a candidate for cytoreductive nephrectomy, systemic therapy with one of the IO/TKI combinations is indicated, taking into consideration the patient’s comorbidity and tolerance to the regimen. (For non-clear cell metastatic RCCs, systemic ...
How do you approach a patient with undifferentiated pleomorphic sarcoma encasing the spinal cord post radiation for neurological deficits for further management?
We will need some more information here. Did the patient present with cord compression? What level of cord is involved? Is the tumor causing functional issues in the patient (paralysis, bladder issues, etc.)? What was the dose of radiation used? Was this definitive RT or palliative RT? Is there any ...
Is narrow-band ultraviolet B (nbUVB) phototherapy contraindicated or recommended with caution in patients with a personal history of melanoma?
Although it is challenging to be definitive, our current literature suggests that nbUVB does not increase the risk of melanoma or nonmelanoma skin cancer.Previous studies suggesting a possible increased risk with nbUVB included patients with a history of PUVA, which has been shown to increase risk. ...
Would you offer a RET inhibitor to a patient with de novo metastatic, RET V706M mutant squamous cell lung cancer?
Yes, it should be effective.
How do you approach RA management in a patient who develops a new solid tumor while on therapy?
Risk-benefit ratios need to be individually assessed. There are several aspects to take into account: Choice of DMARD - Data on impact of various DMARDS on cancer recurrence or progression is scarce, especially for patients with active cancer. In general, there are few concerns for conventional DMA...
Would you rechallenge with cabozantinib in a patient with HCC after the development of a 6 mm gastrohepatic fistula without perforation or communication with the peritoneal cavity?
This is a tough situation. Based on the package insert for Cabozantinib, it can cause GI fistula and perforation in about 1% of patients and any grade 4 should prompt discontinuation of the drug label. The current gastrohepatic fistula without perforation could lead to recurrent abscesses in the liv...
Would you continue venetoclax indefinitely/until disease progression in patients treated with upfront venetoclax for TP53 mutated CLL?
First of all, for the del(17)(p13.1) and/or TP53 mutated CLL patients, venetoclax + obintuzumab may not be the best option based upon data from the CLL14 trial showing early PFS in this group as compared to what has been demonstrated in both up-front ibrutinib and acalabrutinib studies. However, we ...
Would you continue venetoclax indefinitely/until disease progression in patients treated with upfront venetoclax for TP53 mutated CLL?
First of all, for the del(17)(p13.1) and/or TP53 mutated CLL patients, venetoclax + obintuzumab may not be the best option based upon data from the CLL14 trial showing early PFS in this group as compared to what has been demonstrated in both up-front ibrutinib and acalabrutinib studies. However, we ...
How do you consider the role of probiotics for mucositis mitigation in patients receiving head and neck radiotherapy?
This is a very interesting study and I am excited to see continued studies into symptom mitigation for definitive chemoRT. I currently offer Ssk12 to my patients undergoing H+N RT (definitive or adjuvant). I see little potential downside as it is a relatively inexpensive intervention and they report...