Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
What approach do you use when treating adult diffuse gliomas with H3-G34 mutations, now classified into their own category under the 2021 glioma guidelines?
Although DHG H3G34-mutant diffuse gliomas are more commonly associated with pediatric patients, they can occur in young adults as well. In a recent paper describing 17 patients harboring this rare mutation, the median age at diagnosis was 25 years (range: 19–33). All tumors were hemispheric. All cas...
Would you offer consolidative scrotal RT for patients with bilateral testicular lymphoma involvement s/p bilateral orchiectomy and chemotherapy?
I assume you are referring to bilateral scrotal involvement by DLBCL. The initial stage of the disease is also not clear. If both testes have been removed, the risk of involvement with the scrotal sac may be assumed low. However, I would take a good look at the pathology report concerning extratesti...
What induction regimen would you choose for a patient with newly diagnosed multiple myeloma with incidental amyloidosis noted on bone marrow biopsy, but with no end-organ damage as a result of amyloid deposition?
Congo red on a bone marrow is a challenge. The expertise with Congo red is low at most sites in the U.S., hence the sensitivity of the stain in the marrow is 50%. It's worth testing a patient with any Congo red positivity with appropriate cardiac biomarkers, transthoracic ECHOcardiogram, and 24hr ur...
How would you approach treatment of a patient with adenocarcinoma of unknown primary only found in a left supraclavicular lymph node?
Systemic therapy. Palliative RT if necessary
How do you counsel patients with elevated factor VIII levels for their thrombosis risk?
I don't check the factor VIII level as part of a thrombosis workup because the result rarely if ever affects my management of these patients. I would explain to the patient that factor VIII levels are a function of several variables, including age, vascular health (and hence blood pressure, smoking,...
Which patients with cSCC could you omit adjuvant radiation following pathologic complete response following cemiplimab?
I think we need to distinguish between pCR as assessed by a random biopsy versus a complete resection of the involved primary site - the latter is rarely performed since the premise for giving cemiplimab in the first place would have been to avoid a morbid surgery. pCR is not always easy to assess f...
Would you recommend adjuvant capecitabine and radiation in addition to adjuvant FOLFOX for a patient with resected pT3N2 rectosigmoid adenocarcinoma with other high-risk pathologic features?
As with all rectal tumors, those that are labeled as "rectosigmoid" should be reviewed in a multidisciplinary tumor board at a center with deep sub-specialty expertise. In general, radiation is provided for rectal cancers--unlike for colon cancers--because of the increased risk of local recurrence a...
In light of data from PRODIGE7, for patients with peritoneal metastasis from colon cancer, do you still offer HIPEC?
I think the PRODIGE 7 trial, while “negative” for the addition of HIPEC to cytoreduction, was an important trial in highlighting a potentially useful treatment approach for metastatic colorectal cancer with peritoneal only disease. The median survivals are encouraging for patients who receive initia...
How do you decide between HSCT and immunosuppressive therapy for treating hepatitis associated aplastic anemia?
For young people with a donor, the primary therapy is transplantation. It is curative in the vast majority of patients, hepatitis-associated AA is much less likely to respond to immunotherapy.
Can you/do you use an androgen receptor blocker alone in patients with metastatic hormone-sensitive prostate cancer who cannot tolerate GnRH-directed therapy?
Anti-androgen monotherapy for hormone-sensitive (M0 or M1) prostate cancer is not currently supported by FDA approvals or NCCN/AUA guidelines. Two recent studies that have explored enzalutamide monotherapy in patients with M0 and/or M1 hormone-sensitive prostate cancer are shown below. Enzalutamide ...