Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Would you use sutimlimab for cold agglutinin disease/syndrome in patients with a concurrent hematologic malignancy?
The CARDINAL trial excluded patients with active malignancy, and thus in general I would not use sutimlimab in patients with CAD in context of a concurrent hematologic malignancy. Additionally, one would hope that treating the hematologic malignancy would address CAD mediated hemolysis, without requ...
Would you use sutimlimab for cold agglutinin disease/syndrome in patients with a concurrent hematologic malignancy?
The CARDINAL trial excluded patients with active malignancy, and thus in general I would not use sutimlimab in patients with CAD in context of a concurrent hematologic malignancy. Additionally, one would hope that treating the hematologic malignancy would address CAD mediated hemolysis, without requ...
How would you treat a patient with stage IIIA non-seminoma with an anaphylactoid reaction to etoposide during first cycle?
Etoposide is a very important drug in the curative regimens for metastatic testis cancer. BEP, EP, and VIP all incorporate etoposide. Arguably, it is possibly the second most active agent in germ cell tumors. Furthermore, it is highly synergistic with cisplatin. "Anaphylactoid" reactions can be see...
How do you manage a bladder cancer patient who had a partial cystectomy with a positive margin?
In fewer than 5% of bladder cancer patients, partial cystectomy along with neoadjuvant cisplatin-based chemotherapy can be considered for stage II (cT2, N0) disease with a single tumor in a suitable location and no presence of carcinoma in situ, where an adequate margin of soft tissue and an adequat...
How do you approach patients with AL amyloidosis with t(11;14) who have not achieved a hematologic complete response to induction therapy with 6 cycles of Dara-CyBorD?
Achieving an early hem deep response (at least VGPR or better) is crucial for organ response and has demonstrated OS benefit.I would favor changing treatment even by cycle 4 if the hematologic response is <PR. Early switch in such situations led to improved EFS and better chances for an organ respon...
How would you manage elevated vWF and FVIII levels in a patient with a family history of coagulopathy?
Hard to be specific without more clinical details. I would not repeat levels. Although the higher the FVIII and VWF levels, the higher the risk of thrombosis, but there is no known specific cut-off. Currently, there is no role for empiric anticoagulation. As with all patients, DVT prophylaxis in hig...
When, if ever, do you consider administering weekly paclitaxel prior to dose dense AC for neoadjuvant treatment of breast cancer?
There are data that the sequence of initiating neoadjuvant chemotherapy with a taxane prior to an anthracycline may result in greater reduction of circulating breast cancer cells (Pachmann 2004 - page S224). In the small randomized NeoSAMBA trial, T-FAC had improved clinical outcomes, such as DFS, c...
How would you manage BCR-ABL CML that is resistant to imatinib, with concurrent JAK2 mutation?
As Dr. Tremblay mentioned, it’s important to separate the JAK2 component from CML. If the patient truly has a JAK2 mutant MPN, I would treat it depending on what the manifestations of that disease are. On the CML front, I would manage the imatinib resistance the same way you would any other patient....
How would you manage BCR-ABL CML that is resistant to imatinib, with concurrent JAK2 mutation?
As Dr. Tremblay mentioned, it’s important to separate the JAK2 component from CML. If the patient truly has a JAK2 mutant MPN, I would treat it depending on what the manifestations of that disease are. On the CML front, I would manage the imatinib resistance the same way you would any other patient....
How would you manage superficial vein thrombosis that persists on imaging after treatment with full dose anticoagulation?
This is a challenging yet instructive real-life case in clinical decision-making, highlighting variations in practice that often diverge from existing evidence.Before answering let me make some assumptions: Duplex Ultrasound Findings: I assume that Duplex ultrasound did not reveal thrombus extension...