Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Should post-transplant cyclophosphamide be utilized for all matched unrelated donor peripheral blood stem cell transplants for hematologic malignancy?
In myeloablative transplantation, PTCY did not have an advantage over Tac/MTX as demonstrated in the BMT-CTN 1301 study which compared PTCY, Tac/MTX, and T cell depletion (Luznik et al., PMID 34855460). One caveat is that in this trial, PTCY based prophylaxis did not include Tac or Tac/MMF.BMT-CTN 1...
Should post-transplant cyclophosphamide be utilized for all matched unrelated donor peripheral blood stem cell transplants for hematologic malignancy?
In myeloablative transplantation, PTCY did not have an advantage over Tac/MTX as demonstrated in the BMT-CTN 1301 study which compared PTCY, Tac/MTX, and T cell depletion (Luznik et al., PMID 34855460). One caveat is that in this trial, PTCY based prophylaxis did not include Tac or Tac/MMF.BMT-CTN 1...
Do you hold palbociclib (or another CDK4/6 inhibitor) in a patient with metastatic HR+ breast cancer while receiving palliative radiation?
Currently there are no large studies on combining radiation therapy with palbociclib. Many of the patients with hormone receptor positive metastatic breast cancer have bony metastases and often need radiation for palliation. There is a small study showing that combination of radiation and palbocicli...
In a patient with cryptogenic stroke while on antecedent aspirin 81 mg, how do you decide between single antiplatelet therapy, dual antiplatelet therapy, or antiplatelet agent combined with anticoagulation such as rivaroxaban 2.5 mg BID?
This question assumes that a thorough workup has been completed, and the patient does not have paroxysmal a fib, a PFO, an intracranial stenosis, a hypercoagulable state, or vasculitis. This workup is the most important issue. If all is negative, and the stroke is relatively minor (NIHSS less than o...
Would you consider adding abiraterone or docetaxel in patients with high risk prostate cancer whose PSA does not become undetectable after ADT and radiotherapy with castrate level testosterone?
There are three concepts here at its core: Does adding abi or doce to ADT/RT in high-risk PCa improve outcomes in unselected patients? Does a detectable PSA while on ADT impact prognosis? Does intensifying therapy in patients with a detectable PSA while on ADT improve outcomes in this subset? Here a...
How do you approach patients with severe mucositis receiving chemo-radiation for head and neck cancer with regards to empiric antifungal or antiviral treatment?
Severe mucositis remains a problem for patients receiving chemoradiotherapy for locally advanced head and neck cancers. While neutropenia can occur in some patients, it is not as frequently seen when compared to those who undergo bone marrow transplants, meaning that our patients do not commonly dev...
What are alternative myeloma therapies for patients who are unable to afford lenalidomide or oral cyclophosphamide due to gaps in prescription drug coverage?
Unfortunately, this is a big problem, especially in community centers where the resources for grant applications are scarce. At bigger institutions, like ours, we have a dedicated person who searches for all possible grants. If unable to, then the pharma companies have been generous to give free dru...
What are alternative myeloma therapies for patients who are unable to afford lenalidomide or oral cyclophosphamide due to gaps in prescription drug coverage?
Unfortunately, this is a big problem, especially in community centers where the resources for grant applications are scarce. At bigger institutions, like ours, we have a dedicated person who searches for all possible grants. If unable to, then the pharma companies have been generous to give free dru...
What is the recommended approach for a 7 cm x 5 cm paraspinal subcutaneous desmoid tumor (T6 to T9) incidentally detected on PET CT during NSCLC monitoring, with confirmed growth over 18 months?
Medical management is the preferred treatment for patients with desmoid tumors when the DT either causes symptoms (pain, deformity) or has confirmed growth by RECIST criteria over at least 6 months. If this patient has a DT that is worsening over 18 months and threatens the integrity of the spine, t...
What could explain the contradictory results between CheckMate 274, IMvigor010, and AMBASSADOR?
The reasons for the discord between the results of IMvigor010 and CheckMate 274 are unclear and may be multifactorial. In the IMvigor010 trial, the primary endpoint of DFS was not met with adjuvant atezolizumab vs. observation in the ITT population (HR 0·89 [95% CI 0·74-1·08]; p=0·24). The median DF...