Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Would you treat a completely resected Stage IA NSCLC EGFR exon 19 with adjuvant osimertinib alone omitting chemotherapy?
How would you treat a residual mediastinal mass in patients with a mediastinal germ cell tumor with an incomplete response to primary chemotherapy with BEPx4?
Several comments:1. VIP is preferred over BEP for PMNSGCT if there will be consideration for extensive mediastinal resection (JCO 34:4445,2016)2. Patient should be evaluated at a center with experienced and skilled thoracic surgical oncology to determine if patient is truly inoperable.3. Need more i...
For patients with rectal cancer being treated along PROSPECT paradigm, would you extrapolate from the IDEA literature and offer 3 months of CAPOX neoadjuvantly, without adjuvant therapy?
I would! I did it in a recent patient.
Does ctDNA play a “surveillance” role in advanced biliary tract cancers during active therapy assessing response and/or defining relapsing disease?
I do not routinely measure ctDNA in biliary tract cancers to assess response (I do use tumor markers and a good cross-sectional imaging modality such as CT or MRI, however). The investigators on the TOPAZ-1 study have published their work with ctDNA and it does correlate with responders but it is un...
What is your preferred approach to a patient with myeloma who has refractory disease to Dara-VRd in the frontline setting?
Unless the patient is not actually receiving some or all of the Dara-RVd (lenalidomide compliance can be challenging), this functionally defines high risk disease. Most patients don't usually have disease stability for autologous transplant, or even if they are stable for a hot second, transplant pr...
In extremely obese patients with spontaneous DVT/PE who have been anticoagulated for > 6 months, do you feel comfortable reducing the DOAC to prophylactic dose or do you prefer continuing full dose indefinite anticoagulation?
According to the ISTH guidelines (Martin et al., PMID 34259389) in patients with a BMI >40 kg/m2 or weighing >120 kg, it is suggested to use the standard doses of apixaban or rivaroxaban for VTE treatment and prevention regardless of BMI and BW. The ISTH did not discuss dose reduction after 6 months...
How long should we treat patients with newly diagnosed myeloma with bisphosphonates or RANKL inhibitors for their myeloma bone disease given recent data?
The excellent context within the question by @Dr. First Last answers 99% of what I was going to say. This is the MAGNOLIA trial that prompted this question:Lund et al., PMID 38622134 This was a randomized trial of 2 versus 4 years of zoledronic acid in myeloma. Of the 30 cases of bone lesions they f...
How are you dosing IVIG following BCMA CAR-T or bispecific antibodies in multiple myeloma?
At our institution, primary prophylaxis is the rule because we forget. All patients on a bispecific get IVIG 0.4 g/kg (ideal body weight) starting day 1 of the second month and this continues while they remain on the BsAb. Each physician/APC team can stop the IVIG if the IgG > 500 and is self-susta...
Do you use FVIII levels to differentiate between DIC and coagulopathy of liver disease?
DIC is a clinical diagnosis that is difficult to establish in the absence of bleeding or thrombosis, particularly in patients with liver disease. I do think that following DIC laboratory markers (FDP, fibrinogen, D-dimer) serially may be helpful as you would not expect them to acutely drop simply be...
How do you optimize a beta thalassemia patient on luspatercept who is interested in becoming pregnant?
Unfortunately, luspatercept is not approved to be used during pregnancy - there is no data available on the safety of the drug during pregnancy. So would say that if the patient is planning a pregnancy, would stop luspatercept at least 3 months prior. It is strongly recommended to optimize iron bala...