Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
What would you offer to a patient with musculoskeletal pain from tarlatamab, requiring hospitalization and opioid use?
Bone and muscle pain with tarlatamab can be significant (affecting nearly one-third of patients in clinical trials, I think). A multimodal plan combining opioids with non-opioid analgesics, supportive therapies, and proactive side effect monitoring is often necessary to combat this.The pathway that ...
Can RT to non-bulky sites be omitted in an early stage (stage I or II) classical Hodgkin's lymphoma case with a CR by PET/CT?
Randomized studies have consistently demonstrated that combined modality therapy is superior to chemotherapy alone in regards to progression-free survival in early-stage Hodgkin lymphoma. The magnitude of the benefit varies across studies, but a relative risk reduction of ~50% can be expected which ...
Can RT to non-bulky sites be omitted in an early stage (stage I or II) classical Hodgkin's lymphoma case with a CR by PET/CT?
Randomized studies have consistently demonstrated that combined modality therapy is superior to chemotherapy alone in regards to progression-free survival in early-stage Hodgkin lymphoma. The magnitude of the benefit varies across studies, but a relative risk reduction of ~50% can be expected which ...
Do you consider testing and treating IDA in unexplained thrombocytopenia?
Iron deficiency often causes thrombocytosis, and in fact, probably is the most common cause of reactive thrombocytosis encountered in clinical practice. With very severe iron deficiency, thrombocytopenia can be seen. I have seen it in rare patients presenting with hemoglobin levels about 3 gm/dL or ...
Do you consider testing and treating IDA in unexplained thrombocytopenia?
Iron deficiency often causes thrombocytosis, and in fact, probably is the most common cause of reactive thrombocytosis encountered in clinical practice. With very severe iron deficiency, thrombocytopenia can be seen. I have seen it in rare patients presenting with hemoglobin levels about 3 gm/dL or ...
How do the results of the phase 2 TREASURE trial for consolidative RT for ES-SCLC impact your practice?
Thoracic radiotherapy is defined not only by dose, but critically by treatment volume. The TREASURE protocol permitted large CTV expansions, discretionary irradiation of clinically uninvolved nodal regions, and substantial additional PTV margins. Elective nodal irradiation is not part of contemporar...
Does receipt of chemoimmunotherapy for LS-SCLC impact your recommendation for PCI?
Historic data showed that the addition of PCI for patients with limited-stage small cell lung cancer showing response after chemoradiotherapy improves overall survival and decreases brain failure rates by about 50%. Recently, the addition of consolidation immunotherapy after concurrent chemoradiothe...
How do you counsel an otherwise healthy patient on how soon they can go back to moderate exercise after a bilateral pulmonary embolism?
Generally, the approach is to have the patient start their exercise regimen at a lower intensity and gradually increase it based on their tolerance.
Would you recommend chemoimmunotherapy for metastatic anal squamous cell cancer?
Yes. Carboplatin, paclitaxel, and retifanlimab (anti-PD1-antibody) are a preferred, guideline-recommended treatment for metastatic squamous cell cancer of the anus. The efficacy of this regimen was confirmed in the POD1UM-303/InterAACT-2 phase 3 trial, which randomized patients (n=308) to carboplati...
Assuming approval, in which patients would you choose Belzutifan + Lenvatinib (LITESPARK-011) for advanced RCC, with progression after IO therapy?
LITESPARK-011 is an interesting study as it relates to current standard practice. Presently, lenvatinib/everolimus is a well-established and potent treatment option. Each clearly contributes towards the clinical benefit observed in most patients. For instance, in the study NCT01136733 (Motzer et al....