Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
When would you consider using G-CSF in patients with rheumatic disease who have received cyclophosphamide?
Our primary concern would be our patients with systemic lupus erythematosus. There are reports of severe flares in SLE patients treated with G-CSF (vasculitis and nephritis; Vasiliu et al, PMID 16832843) and even reports of cardiac arrest (Ragsdale & Hall Zimmerman, PMID 34748466).Of course, this ne...
Will prior novel hormonal therapy affect when/how you use olaparib plus abiraterone for patients with BRCA-mutated metastatic castration resistant prostate cancer?
Yes, there is no clear data at this time that an AR/PARP inhibitor combination prolongs rPFS or OS in men with mCRPC who have progressed on a prior potent AR inhibitor, as largely these men were excluded or not included in PROpel, MAGNITUDE, or TALAPRO-2. For patients who develop mCRPC but have not ...
Would you offer adjuvant immunotherapy in an elderly patient with stage IIB desmoplastic melanoma post resection with underlying autoimmune disease?
As discussed with our desmoplastic melanoma expert at The Ohio State University, Kari L. Kendra, MD - "Because some patients are potentially "cured" with surgical resection alone and this patient has an autoimmune disease, would not treat in the adjuvant setting. If there is local recurrence, would ...
In a patient with local recurrence of breast cancer after mastectomy, how would you sequence adjuvant treatment after wide local resection?
Endocrine therapy can be given simultaneously with RT without increasing toxicity or decreasing effectiveness, as shown in a randomized French-Swiss trial (Azria et al., PMID 20138810). Toxicities from chemotherapy may be greater and its effectiveness reduced (at least for high-risk patients) when g...
Do you consider using 160 mg osimertinib in patients with EGFR-positive metastatic NSCLC to the brain?
The BLOOM study [Yang et al., PMID 31809241] was the first to address the question of CNS dosage for patients with EGFR mutant NSCLC with brain metastases. In this, patients with cytologically confirmed leptomeningeal (LM) disease received osimertinib 160 mg once daily. LM disease was assessed by bl...
Do you recommend neoadjuvant chemotherapy or induction chemo + chemoRT for borderline resectable pancreatic cancer?
The definition of BRPC has expanded to include everything from minimal venous involvement to 180 degree abutment of the SMA. It is important to determine if there is arterial involvement. If there is, the best data show that XRT helps with R0 resections. In our experience at MDACC, 95% of patients w...
How would you manage a patient with new FDG avid retroperitoneal lymph nodes after completing definitive chemoradiation for stage III anal canal cancer?
I agree with @Dr. First Last. PA nodes are not really systemic disease if you consider the disease biology. They are regional nodes. There is 100% RR and >90% LC with chemoradiation with very low risk.
Is there any data to support the combination of a CDK 4/6 inhibitor with tamoxifen?
The best data for this combination comes from MONALEESA-7, which combined tamoxifen or an AI (+ ovarian suppression in all patients) with ribociclib or placebo in premenopausal women with advanced HR+, HER2 negative breast cancer. This was presented at SABCS 2017. Tamoxifen treatment was selected in...
Would you ever consider foregoing surveillance CT scans for resected stage II or III colon cancer in favor of circulating ctDNA assays?
As someone who was introduced to CEA in colon surveillance when discovered simultaneously by Gold and LoGerfo in the early 1970s, I am excited by the rapid acceptance of ctDNA in evaluation and management of colon cancer. We know that ctDNA can be positive up to 9 months before a CT scan demonstrate...
How do you approach initial treatment for AL amyloidosis with excess plasmacytosis in the bone marrow, that has cardiac involvement and is not a transplant candidate?
This is the mirror image of an earlier question on theMednet, namely how we would approach MM treatment in someone who was incidentally diagnosed with AL amyloidosis:https://www.themednet.org/question/13482Here, it's how we would approach AL amyloidosis with someone well over 10% bone marrow plasma ...