Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
What changes do you make in the management of non-endemic nasopharynx cancer compared to endemic?
a) There are 3 varieties of NPC; EBER +ve, HPV +, and non-viral There is only decent data for Induction (IC) for EBER +ve for a small survival benefit with cis-gem, and the group's follow-up suggested that pre-treatment DNA titers only showed benefit for those with high titers. I am not a HN med onc...
How do you approach imetelstat therapy in MDS patients with baseline neutropenia or thrombocytopenia?
Given the fact that the major treatment-emergent adverse events noted on the phase III IMERGE study in the imetelstat-treated arm were neutropenia (68% Grade 3+ tox) and thrombocytopenia (62% Grade 3+ tox), it makes it somewhat difficult to utilize imetelstat (Platzbecker et al., PMID 38048786) in p...
How do you approach imetelstat therapy in MDS patients with baseline neutropenia or thrombocytopenia?
Given the fact that the major treatment-emergent adverse events noted on the phase III IMERGE study in the imetelstat-treated arm were neutropenia (68% Grade 3+ tox) and thrombocytopenia (62% Grade 3+ tox), it makes it somewhat difficult to utilize imetelstat (Platzbecker et al., PMID 38048786) in p...
Would you continue serial PSMA PET scans after 2 negative scans for patients with a persistently rising PSA post-RT?
Some context would probably be helpful for this. E.g., PSA >2 is different for a patient post-prostatectomy vs. post-radiotherapy. But, in general, if clinical suspicion of cancer recurrence/progression is high, and PSMA PET is negative, one can consider the following options: There may not be a ca...
For patients undergoing bladder preservation therapy with trimodal therapy, how do you manage the urinary urgency and frequency during and after treatment?
This can be a difficult problem to manage because I try to avoid treatment interruption if at all possible, which is different from my approach in patients with prostate cancer, where treatment interruption is a safe and effective alternative. In patients with bladder cancer, the first thing I will ...
What are your recommendations for holding bevacizumab before and after SBRT to the lung?
As @Dr. First Last notes, our experience at Memorial Sloan Kettering has indicated that giving SBRT for ultra-central lung tumors in a patient who has also been exposed to VEGF inhibitors may be an extremely dangerous combination associated with a high risk of fatal pulmonary hemorrhage. This work w...
How do you approach patients with metastatic castrate sensitive prostate cancer who have discrepant PSA and radiographic response to upfront triplet therapy?
The situation where PSA response is discordant from changes in PSMA uptake is always very challenging. In this case, a bone biopsy has shown persistence of adenocarcinoma and absence of small cell transformation. In the SWOG GU committee some years ago, we showed that a > 90% reduction in PSA porten...
Would you offer neoadjuvant chemotherapy to premenopausal women with cT1cN0 HER2+ breast cancer?
Since most neo-adjuvant trials required that primary tumor was at least 2 cm, I tend to lean towards upfront surgery. If the tumor size is confirmed and sentinel lymph nodes are negative, the patient could be offered paclitaxel and trastuzumab which is significantly less toxic than pertuzumab in com...
How would you manage superficial thrombophlebitis of the great saphenous vein involving the knee and calf?
I would point you to an excellent algorithm created by Sherry Scovell on UpToDate, "Superficial Vein Thrombosis and Phlebitis of the Lower Extremity Veins" which has informed my practice. The highlights of the approach utilized are to perform imaging with Doppler ultrasound to determine the length o...
How do you approach the treatment of teen patients with recurrent mediastinal germ cell tumor who have failed standard therapy, radiation, and HD therapy/stem cell rescue?
The query failed to delineate whether this was seminoma or non-seminoma, but probably does not matter in this advanced stage of a heavily treated patient. Also failed to address the anatomical location of active cancer. Whether this is a teen or older patient is irrelevant. For mediastinal seminoma,...