Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Is there any value to getting a bone marrow biopsy at the time of biochemical relapse in multiple myeloma before switching to a new line of therapy?
Not really. I'm sure there is a patient out there where FISH failed on all the prior bone marrow biopsies and finally, at this relapse, a t(11;14) is discovered which brings BCL2 inhibition into the treatment discussion. Physicians who are less familiar with myeloma will often repeat the bone marrow...
Would you irradiate all borderline suspicious lymph node regions on PET/CT in stage IIA nodular lymphocyte predominant Hodgkin's lymphoma treated with ISRT alone?
ISRT fields for lymphocyte predominant HL when treating without chemotherapy should be more generous in the nodal chain region than if treated with chemotherapy. We conducted a survey of expert lymphoma radiation oncologists published in the IJROBP, which demonstrated some differences in opinion. Ho...
What is the best treatment volume and dose for a marginal zone orbital lymphoma?
It would depend on the location- retrobulbar, conjunctival or lacrimal gland. Imaging, including MRI, helps in evaluating the site of origin and extent of involvement. Some advocate treating the entire orbit for all orbital lymphomas to be comprehensive, as the total dose is low, and this away we av...
How do you follow patients after radiation treatment for orbital MALT lymphoma?
Local control is extraordinarily high after definitive RT (24 Gy) for orbital MALT lymphoma (>95%). It is not uncommon for patients with retro-orbital disease to have residual masses after RT that remain stable during follow-up. One should be cautious about pursuing additional therapy for presumed "...
Would you require biopsy of both orbits or is unilateral biopsy adequate for a patient with suspected bilateral orbital MALT lymphoma?
Biopsy of one orbit is sufficient if clinical findings and images of the other orbit are all consistent with marginal zone lymphoma (MZL). I’m a little surprised the question of how to treat bilateral MZL of orbit was not asked. Assuming disease is limited to the orbits, radiotherapy to both sites w...
How would you manage a localized small cell carcinoma of the anal canal without nodal or distant disease?
High-grade, poorly differentiated neuroendocrine carcinoma (NEC) of the anorectum is a highly aggressive malignancy associated with a very poor prognosis. For truly localized disease (FDG PET negative for extrapelvic and nodal disease), the outcomes are still poor. The majority of patients with loco...
What are your top takeaways in Head & Neck Cancers from ASCO 2022?
In nasopharyngeal cancer, the group from Sun Yat-Sen University presented the results of a non-inferiority, randomized phase III study comparing RT alone vs RT concurrent with cisplatin for intermediate-risk patients (stage II and T3N0M0) (Ma et al., 2022 ASCO Annual Meeting, abstract #6000). They f...
What is your approach to management of chronic neutropenia in a patient with Sjogren’s who was recently diagnosed with metastatic endometrial cancer and plans to start chemotherapy?
With metastatic cancer, optimal treatment of the endometrial cancer is the priority. Heme/Onc consultant would likely be giving granulocyte stimulating products.Although neutropenia can occur in Sjogren's Disease (SjD), I rarely have found it to be clinically significant, and lymphopenia seems to oc...
How do you manage taxane acute pain syndrome (TAPS)?
A number of pharmacological agents have been reported as options for TAPS. These include NSAIDs, steroids, antihistamines, tricyclic anti depressants, antiepileptics, and glutamine. I have used most of these except glutamine, with moderate success. I usually start with NSAIDS and consider adding sho...
Is bilateral hearing loss requiring hearing aids an absolute or relative contraindication for neoadjuvant cisplatin in MIBC?
For this “curative intent” neoadjuvant therapy setting, a detailed discussion with the patient is very helpful and should include the pros/cons of cisplatin based chemotherapy based on phase 3 trials data and a meta-analysis showing OS benefit as well as possible side effects, including hearing loss...