Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
What are your top takeaways in GI Cancers from ASCO 2024?
Here are my top 3 ESOPEC with a 29-month survival advantage for FLOT chemotherapy over Cross-type chemoradiation for esophageal adenocarcinoma. New standard of care - we need to get used to using FLOT. CheckMate 8HW set a standard of ipi/nivo in dMMR colorectal cancer, with immunotherapy being v...
How would you treat a patient with emergence of EGFR C797S mutation at the time of progression on osimertinib given for EGFR T790M mutation?
Although I don't have a personal experience, there are reports of adding 1st or 2nd gen EGFR TKI such as gefitinib or erlotinib to Osimertinib.J Thorac Oncol. 2017 Nov;12(11):1728-1732. doi: 10.1016/j.jtho.2017.08.006. Epub 2017 Aug 24.Combination Osimertinib and Gefitinib in C797S and T790M EGFR-Mu...
Which patients with localized esophageal adenocarcinoma, if any, would you offer nivolumab after lack of pCR to neoadjuvant FLOT?
I have not been in such a situation, yet, but I am sure will be soon! My thought will be to start off with patients with a PDL1 score of at least 5. Not sure the degree of path response can predict immune therapy sensitivity, so at this time, I would treat all except the pCR but may also consider li...
What dose and fields would you use to treat a low grade CNS lymphoma that presents as an isolated single mass in the brain?
De novo presentations of low-grade lymphomas in the brain parenchyma are very, very rare. Suppose a patient had a relatively small, well-localized, low-grade NHL such as FL or MZL in the brain parenchyma, without any evidence of disease elsewhere (negative PET-CT, bone marrow biopsy, etc.). In that ...
When and how do we do cytoreduction in CLL?
Cytoreduction is almost never needed in CLL just for the sake of lowering the number. Rare case reports exist of leukostasis with WBC counts over 700k, but these are exceptions. If there are leukostasis symptoms with lower WBC counts then the diagnosis of CLL should be questioned. Having said that, ...
When and how do we do cytoreduction in CLL?
Cytoreduction is almost never needed in CLL just for the sake of lowering the number. Rare case reports exist of leukostasis with WBC counts over 700k, but these are exceptions. If there are leukostasis symptoms with lower WBC counts then the diagnosis of CLL should be questioned. Having said that, ...
How do you manage hypoxia induced by belzutifan?
Hypoxia is an on-target adverse effect (AE) of belzutifan. All-grade hypoxia was reported in 14.5% of patients (10.5 %, grade 3 and above) in the LITESPARK-005 trial (Choueiri et al., PMID 39167807). Discontinuation of belzutifan due to hypoxia was <1%. Of note, patients with hypoxia (<92% of oxygen...
What group of early pancreatic cancer patients, such as pT1a, can be excluded from adjuvant chemotherapy post resection?
Short answer is none - all patients who have undergone surgery for pancreatic cancer benefit from adjuvant chemotherapy, as long as they can tolerate it.But to be a bit more detailed: Both the Neoptolemos, ESPAC-4 adjuvant trial of gem+cap, and the Conroy PRODIGE 24–ACCORD adjuvant trial of FOLFIRIN...
Is there any role for palliative radiation in patients who are intubated due to malignant airway obstruction?
The literature is limited, but this small series showed about 1/4 of patients can have reversal of intubation.If the patient/family is interested in attempting, it occasionally works, but my own experience is less successful than 1/4. It is unlikely to worsen the situation, so after explaining that ...
How would you treat metastatic pure tubulocystic renal cell cancer?
Tubulocystic renal cell carcinoma (tcRCC) is a very rare diagnosis--particularly metastatic tcRCC. To my knowledge, there are no clinical trials that have reported on these patients even in the basket non-clear cell RCC trials such as ASPEN (Armstrong et al., PMID 26794930) and ESPN (Tannir et al., ...