Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
When do you initiate androgen deprivation therapy for biochemical relapse of prostate cancer following primary therapy?
There is no right or wrong answer here. The Johns Hopkins approach is to always recommend a clinical trial for the nonmetastatic BCR population. In the absence of a trial, our group does not believe that early ADT is justified in men with PSADT >9 months, where metastasis-free survival approaches 10...
How do you modify Daratumumab-RVD relative to the protocols used in trials when used as a first-line agent to transplant-eligible patients with myeloma?
My modifications based off the GRIFFIN trial (Voorhees et al., PMID 32325490) are as follows: If patients have high burden disease and no underlying neuropathy, I will start with twice-weekly bortezomib (days 1, 4, 8, 11) but will change the dexamethasone to 20 mg days 1, 4, 8, 11, and 15 using the ...
How do you modify Daratumumab-RVD relative to the protocols used in trials when used as a first-line agent to transplant-eligible patients with myeloma?
My modifications based off the GRIFFIN trial (Voorhees et al., PMID 32325490) are as follows: If patients have high burden disease and no underlying neuropathy, I will start with twice-weekly bortezomib (days 1, 4, 8, 11) but will change the dexamethasone to 20 mg days 1, 4, 8, 11, and 15 using the ...
For those rare patients now out 5 years post GBM treatment and continuous Optune, is there a point one would stop Optune?
I haven’t seen any data from Optune on these very long term survivors. They have released some subset data that patients who used the device 90% of the time or greater had a 29% chance of being alive at 5 years which is pretty remarkable. Certainly think there are diminishing returns beyond 5 years....
How do you approach the management of a patient with lumbar spinal metastasis with neurologic symptoms but without evidence of spinal cord compression?
From the brief description included, it appears that the lesion is at the level of the cauda equina, a group of nerves and nerve roots stemming from the distal end of the spinal cord, typically levels of L1-L5, and contains axons of nerves that give both motor and sensory innervation to the legs, bl...
What criteria do you use to decide whether to start anticonvulsants in patients with brain metastases?
Patients with intact brain metastases in the absence of seizure activity should generally not be receiving prophylactic anticonvulsants based on 2019 guidelines from the Congress of Neurologic Surgeons subsequently endorsed by SNO and ASCO. The practice of prophylactic AEDs in the post-op setting is...
How do you time CSF analysis for suspected CNS lymphoma in patients who are on steroids?
As soon as possible. The diagnostic yield of biopsy or LP can diminish very quickly after steroid initiation. Holding steroids for 7-10 days if possible is one common strategy to try to mitigate this. If steroids are unavoidable, or if tapering/holding them is not feasible, additional strategies to ...
How do you time CSF analysis for suspected CNS lymphoma in patients who are on steroids?
As soon as possible. The diagnostic yield of biopsy or LP can diminish very quickly after steroid initiation. Holding steroids for 7-10 days if possible is one common strategy to try to mitigate this. If steroids are unavoidable, or if tapering/holding them is not feasible, additional strategies to ...
When is the best time to try targeted therapy in adult-type diffuse non-IDH glioma?
Has this practice changed since posted?
Would you offer immunotherapy to a patient with stage II NSCLC with an EGFR exon 20 mutation?
Data from Tsuji et al., PMID 38287788 and Naidoo et al., JCO 2022 suggest that patients with EGFRm NSCLC do not benefit from durvalumab after concurrent CRT. While the majority of patients studied had tumors driven by classic sensitizing mutations, atypicals were included in the series from Japan. B...