Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How do you approach MDS patients with low/very low risk IPSS-R but high risk mutations on NGS?
This a great question and one that I think will become more frequent in clinical practice. As it stands in my practice currently, I have been managing my IPSS-R low/very low-risk patients as I always have, with either observation, ESAs, or lenalidomide (in the case of those with del 5q). Age and com...
How do you approach MDS patients with low/very low risk IPSS-R but high risk mutations on NGS?
This a great question and one that I think will become more frequent in clinical practice. As it stands in my practice currently, I have been managing my IPSS-R low/very low-risk patients as I always have, with either observation, ESAs, or lenalidomide (in the case of those with del 5q). Age and com...
How do you workup splenomegaly related to possible hematologic etiology in the absence of abnormal blood counts, adenopathy or severe constitutional symptoms?
The presence of splenomegaly is an important finding found either on physical exams or by imaging. As noted in the question, the initial work up includes physical exam looking for lymphadenopathy. In addition, laboratory evaluation, including absolute white count, and differential may help explain w...
How would you treat newly diagnosed stage IV GEJ adenocarcinoma with both Claudin 18.2 and HER2 (3+ via IHC) overexpression?
Would treat as any other HER+3. FOLFOX+Trastuzumab and add pembrolizumab only if PDL1+. Given the lack of data, would not add zolbe.
How would you approach patients with high risk mucoepidermoid carcinoma (high grade) of the parotid gland for optimal adjuvant treatment?
Would be nice to know all the risk factors - margins, PNI, etc.Due to high-risk features, adjuvant RT is appropriate and guideline-concordantHowever, there is no strong supporting evidence to add adjuvant chemo as salivary gland cancers are typically not chemo-sensitive.Published real-world data suc...
Is there any evidence for amyloid/amyloidosis causing a spurious/false PSA reading?
This is an excellent question.Our group has been involved with amyloid/radiation effects in patients with Alzheimer’s disease Turn our initial run-up and through our most recent reviews, I have not seen any significant publications nor have I seen clinical situations that this addresses, although am...
Is there any evidence for amyloid/amyloidosis causing a spurious/false PSA reading?
This is an excellent question.Our group has been involved with amyloid/radiation effects in patients with Alzheimer’s disease Turn our initial run-up and through our most recent reviews, I have not seen any significant publications nor have I seen clinical situations that this addresses, although am...
What is your preferred systemic treatment for patients progressing during or soon after completion of consolidation durvalumab for unresectable NSCLC?
This is an excellent question for which (to my knowledge) no randomized prospective data is available. As this is a frequent clinical scenario, one would hope that investigators in the thoracic oncology field would perform such a study in the future. That being said, I can see the rationale for givi...
How would you manage a young woman with vulvar langerhans cell histiocytosis and positive margins after wide local excision?
It is a complex situation/question, with no major existing studies to answer it directly. Further management depends on various factors- are there other sites of disease on full-body PET CT scan? Is further surgery possible without any disfigurement or major cosmetic issues? If localized disease onl...
How would you approach langerhans cell histiocytosis involving a single bone site after resection?
The outcomes for single-site LCH in adults are generally excellent. However, there is still a small risk of relapse. At this time, factors predicting relapse are unknown. It is recommended to ensure that it is truly a single-site disease by FDG PET scan and there is no diabetes insipidus. If yes, th...