Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
What is the recommended treatment approach for stage III/IVA nasopharyngeal cancer that is p16 negative and EBV positive?
The recommended treatment approach for stage III/IVA EBV-positive nasopharyngeal cancer is induction chemotherapy with gemcitabine/cisplatin followed by concurrent chemoradiotherapy with cisplatin.This was established in a phase 3 trial that compared induction chemotherapy plus concurrent chemoradio...
In what situations would you consider doublet chemotherapy in treatment of a premenopausal de novo metastatic TNBC?
I use a doublet in patients with symptomatic disease or large disease burden. Shortness of breath or pain from locally advanced disease and significant liver disease burden are typical examples. These are situations where a higher disease response matters for quality of life and improving symptoms ...
How do you monitor multiple myeloma in patients receiving dialysis?
In brief, it depends. I’ve had some patients on dialysis whose light chains completely normalize with treatment and continue to remain normal - and others where the light chains never drop below 100 mg/L even in the setting of MRD negativity. This probably has something to do with the fact that not ...
How do you monitor multiple myeloma in patients receiving dialysis?
In brief, it depends. I’ve had some patients on dialysis whose light chains completely normalize with treatment and continue to remain normal - and others where the light chains never drop below 100 mg/L even in the setting of MRD negativity. This probably has something to do with the fact that not ...
Would you change treatment approach for rectal cancer with an associated intussusception?
If the patient has obstruction, I probably would favor surgery first. If not, then I'd treat it as usual. It's a judgment call though.
Would you give adjuvant anti-hormonal therapy after bilateral mastectomies for multifocal/multicentric high grade DCIS?
No. Since DCIS does not metastasize, the purpose of endocrine therapy, with either tamoxifen or and AI after DCIS, is to decrease the risk of local recurrence and new breast cancers. Having bilateral mastectomy decreases the risk by >90%, such that the additional benefit of preventive endocrine ther...
Would you continue durvalumab beyond 12 months in an oligometastatic NSCLC patient treated with concurrent CRT followed by consolidation durvalumab after treating a single metastatic site?
There are really a few questions here. The first is duration of durvalumab, and I agree with prior answer by @Dr. First Last that stopping at 1 year is appropriate given that was specified in PACIFIC (though only 42% of patients actually completed 1 yr of durvalumab in the study). Then there is the ...
Would you recommend oral or intravenous iron in a chronic kidney disease stage 4 patient who is not on an ESA and has a hemoglobin of 12.7 g/dl and an iron saturation of less than 20%?
I would not necessarily treat this patient with iron at all. I would check serum ferritin. If low would do a colonoscopy or look for causes of iron deficiency. If not low would observe. In general though for patients with CKD (not on dialysis yet) who need iron therapy, I would try oral iron first. ...
For incidentally found stage I indolent non-Hodgkin's lymphoma in young patients, which subtypes would more strongly warrant a consideration for curative-intent radiation?
In general, national guidelines recommend definitive RT for early-stage, low-grade NHLs. These are a diverse collection of diseases with different natural histories and outcomes after treatment. In brief... 1. Follicular lymphoma - typically a disease of older adults with ~20% presenting with early-...
For plasmablastic lymphoma responsive to treatment except for a recurrent lymph node eroding into a vertebral body at the end of chemotherapy, would you cover the entire vertebral body in your CTV, or treat only the involved lymph node with a margin?
Plasmablastic lymphoma is an aggressive NHL that typically occurs in the H&N region, typically in immunosuppressed individuals. Most patients present with advanced disease. The role of RT is not firmly established. That said, in a patient only achieving a PR to systemic therapy with localized residu...