Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
What treatment would you recommend for a patient with non-mutated Stage III lung squamous cell carcinoma with relapse following neoadjuvant chemoimmunotherapy, surgery, and during adjuvant immunotherapy?
If relapse is later than 6 mo since chemo discontinued, retreat with the same chemo. If relapse is less than 6 mo, can consider alternative therapy such as doce +/- ram, a clinical trial, or pembro/ramicirumab as in SWOG trial.
In a patient with a Factor V Leiden heterozygous mutation but no prior thrombosis, would you consider using a JAK inhibitor for the treatment of spondyloarthritis or rheumatoid arthritis if other options have been ineffective?
1. I'd love to hear others' thoughts who are more versed in thrombotic diastheses and JAKi's.2. The only article I could find assessing this showed no differences between the JAKi arm and the tumor necrosis factor inhibitor arm regarding patients with thrombophilia mutations (Weitz, et al., PMID 363...
How would you manage an elderly patient with mild pancytopenia who refuses bone marrow biopsy and whose flow cytometry is suggestive of CMML/MDS?
It depends on the actual age of the patient - 70s, 80s versus 90s. If 80s or 90s and not transfusion dependent - suggest observation as likely low-risk disease. Alternatively, if there is a need to start hypomethylating agents then would send peripheral blood for NGS and cytogenetics especially if h...
How would you manage an elderly patient with mild pancytopenia who refuses bone marrow biopsy and whose flow cytometry is suggestive of CMML/MDS?
It depends on the actual age of the patient - 70s, 80s versus 90s. If 80s or 90s and not transfusion dependent - suggest observation as likely low-risk disease. Alternatively, if there is a need to start hypomethylating agents then would send peripheral blood for NGS and cytogenetics especially if h...
How do you approach the management of basal cell carcinoma with single lymph node involvement?
If all the tumor has been resected, I would recommend adjuvant XRT on the nodal basin, depending on the age of the patient. For very old patients or patients with comorbidities, observation might be warranted. If there is remaining BCC visible on examination or scans, I would treat systemically with...
What is your preferred graft source and conditioning regimen in a patient with Fanconi anemia and AML undergoing stem cell transplant?
I'm assuming that the patient has now secondary AML evolving from FA. If this is the case, I would suggest a reduced-toxicity MAC with Flu-based regimen and avoiding TBI (for obvious reasons). An IV BU PK-directed regimen such as Bu4Flu seems to be a reasonable regimen. As for the source, BM is pref...
What is your preferred graft source and conditioning regimen in a patient with Fanconi anemia and AML undergoing stem cell transplant?
I'm assuming that the patient has now secondary AML evolving from FA. If this is the case, I would suggest a reduced-toxicity MAC with Flu-based regimen and avoiding TBI (for obvious reasons). An IV BU PK-directed regimen such as Bu4Flu seems to be a reasonable regimen. As for the source, BM is pref...
How would you approach a patient who responded to CDK4/6 inhibitor/endocrine therapy combination for metastatic HR+,HER2- breast cancer who now has disease progression which is biopsy proven TNBC?
If she has no other distant sites of progression through the cdk4/6, then I would continue this post mastectomy. I would only switch if you have new growing distant mets.
Are there clinical features that would lead you to consider combining SBRT + immunotherapy in a high risk early stage NSCLC?
I currently only use SBRT + immunotherapy in medically inoperable, early-stage NSCLC on clinical trial, as it is not yet a standard of care for early-stage disease. There are several randomized phase 3 trials currently testing immunotherapy in this patient population, however. On SWOG/NRG S1914, a p...
Would you consider adding pembrolizumab to adjuvant chemotherapy in a patient with stage 3 TNBC who did not receive neoadjuvant treatment?
It seems that we might be missing some key clinical information here. However, I assume that this was high risk enough - given the ki-67, potentially LN positive, and larger size tumor to make the treating physician concerned. As a first point, while the ctDNA reflects (based on accumulating data) p...