Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
What would be your approach in a patient who presented with a solitary brain metastasis that resolved after chemo without local therapy?
While I have not had this happen with my patients receiving chemotherapy alone, in the era of targeted therapies for oncogenic driver mutated NSCLC, we have had some great intracranial response rates with systemic alone, and for these, I have held off SRS to evaluate response. In someone with a comp...
How do you manage IgM related peripheral neuropathy?
First things first, let's make sure it's IgM related. In patients with precursor disease (MGUS or smoldering) and neuropathy, I check B12, HbA1c, TSH, free T4, hepatitis B surface Ag, hepatitis B total core Ab, hepatitis C antibody, and cryoglobulins. In patients with specific risk factors, I check ...
Is there any benefit to using desmopressin over vWF replacement therapy for vWD?
For mild type 1 and 2A, we do offer DDAVP testing and use. It was a much more useful drug when it was widely available as a nasal spray. It still has its place, but with patients whose level of VWF is <20% baseline, we have a lot of treatment failures and end up using factor.
In light of ARASENS presented at GU ASCO 2022, how do you approach treatment of de novo metastatic hormone sensitive prostate cancer?
There are multiple factors that go into treatment decisions for men with mHSPC, but two of the most important are volume of disease and de novo vs relapsed disease (i.e. prior local therapy). Volume of disease is one of the major factors for deciding on the benefits of docetaxel, with very limited b...
Is it reasonable to extrapolate data from Glioblastoma and discuss Tumor Treating Fields in patients with Grade 4, IDH Mutant, astrocytomas?
While more than 90% of Grade 4 gliomas are IDH wildtype tumors (GBMs), this question does come up occasionally. Since I have no personal experience with TTF, I asked my collaborator Chirag Patel, MD, a neuro-oncologist at MDACC who regularly uses TTF in his patients, to provide his opinion. So pleas...
Do you recommend routine use of Evusheld for pre-exposure prophylaxis for patients on immunosuppression?
The use of monoclonal antibodies as passive immunity for pre-exposure prophylaxis is an exciting development for vulnerable patients, including immunosuppressed patients (either primary or through medications such as for autoimmune diseases), cancer patients, and organ transplant recipients. Evushel...
Do you recommend routine use of Evusheld for pre-exposure prophylaxis for patients on immunosuppression?
The use of monoclonal antibodies as passive immunity for pre-exposure prophylaxis is an exciting development for vulnerable patients, including immunosuppressed patients (either primary or through medications such as for autoimmune diseases), cancer patients, and organ transplant recipients. Evushel...
Does the degree of elevation in free light chains/ratio correlate with a probability of AL amyloidosis?
YES, the difference between the kappa and lambda free light chains (dFLC) correlates with the probability of a diagnosis of AL amyloidosis. A significant dFLC indicates a higher likelihood of the disease and can also provide some moderately valuable prognostic information.But NO, I have not seen dat...
Does the degree of elevation in free light chains/ratio correlate with a probability of AL amyloidosis?
YES, the difference between the kappa and lambda free light chains (dFLC) correlates with the probability of a diagnosis of AL amyloidosis. A significant dFLC indicates a higher likelihood of the disease and can also provide some moderately valuable prognostic information.But NO, I have not seen dat...
How do you manage colorectal tumors that have components in the colon and rectum on MRI?
For a tumor straddling the peritoneal reflection, it is only the rectal component that would make one consider RT. The reason for a local recurrence of rectal cancer is residual disease from the primary tumor either at the margin of resection of the primary tumor or from residual lymph nodes in the ...