Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How would you treat an older patient with multiple co-morbidities and borderline performance status with resectable esophageal cancer in light of ESOPEC trial?
This is a great question. There is lacking data to answer your question, so you are getting my professional opinion and that which I heard discussed at the recent Best of ASCO by Binaytara. The simple answer: yes. We as oncologists need to know the data, know what is "optimal" and individualize for...
Would an MPL variant mutation of unknown clinical significance be considered diagnostic of essential thrombocytosis in a patient with longstanding elevation in the platelet count, and for whom all secondary causes have been excluded?
A bone marrow biopsy should be performed if not already done to complete diagnostic work-up for an MPN. If the MPL variant is truly of unknown significance, then that alone is not diagnostic of an MPN. The WHO 5th edition criteria for ET diagnosis are summarized in Loghavi et al., PMID 38043791 and ...
Would an MPL variant mutation of unknown clinical significance be considered diagnostic of essential thrombocytosis in a patient with longstanding elevation in the platelet count, and for whom all secondary causes have been excluded?
A bone marrow biopsy should be performed if not already done to complete diagnostic work-up for an MPN. If the MPL variant is truly of unknown significance, then that alone is not diagnostic of an MPN. The WHO 5th edition criteria for ET diagnosis are summarized in Loghavi et al., PMID 38043791 and ...
How do you approach adjuvant treatment of pT1cN0 metaplastic triple negative breast cancer?
Triple negative metaplastic breast cancers (TNMetBC) are rare, relatively chemorefractory tumors that behave quite differently from triple negative ductal cancers. (Reddy et al., PMID 33148288) The two types are usually treated similarly due to a lack of conclusive data on how to optimally treat TNM...
What is your perioperative approach to holding and restarting hydroxyurea in patients with essential thrombocythemia?
I would like to rephrase the question since as written, the assumption is that hydroxyurea is a preferred therapy for ET, when any careful reading of the literature will show that there is no proven rationale for using chemotherapy of any sort routinely in ET. There is no association between the pla...
What is your perioperative approach to holding and restarting hydroxyurea in patients with essential thrombocythemia?
I would like to rephrase the question since as written, the assumption is that hydroxyurea is a preferred therapy for ET, when any careful reading of the literature will show that there is no proven rationale for using chemotherapy of any sort routinely in ET. There is no association between the pla...
When do you re-image patients with a diagnosis of venous sinus thrombosis?
My practice is to perform early reimaging, typically at around 2 weeks, before transitioning from parenteral anticoagulation to oral anticoagulation. This early reassessment is important as recanalization processes begin early and are linked to clinical outcomes. Subsequent imaging at 6 months is al...
How would you approach a patient with desmoplastic melanoma (pT3N0M0) post resection for adjuvant treatment?
Dr. @Dr. First Last - Could you please clarify if there is ulceration or not? That will help us to know if this is stage IIA or IIB melanoma.If this is pT3aN0Mo disease, then this is stage IIA melanoma and dermatology surveillance is offered. No systemic imaging for surveillance is indicated. No adj...
Is S1800A data sufficient to adopt ramucirumab + pembrolizumab in your clinical practice immediately, or is phase 3 data needed?
The control arms in S1800A were docetaxel + Ram (67%) but the other 33% received single-agent docetaxel, gemcitabine, etc. The primary endpoint was overall survival which was reached, but for what it was worth no difference in PFS. In my opinion, it is possible that the modest survival benefit with ...
Does cytotoxic chemotherapy affect the yield of germline testing?
Chemotherapy does not typically affect the yield or accuracy of germline testing for genetic mutations. Germline testing analyzes a person's DNA from a blood sample or other tissue to identify inherited genetic variants. This type of testing focuses on the genetic information that is present in the ...