Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How do you manage an intramedullary benign nerve sheath tumor post sub-total resection seen on post-operative MRI?
Intracranial schwannomas respond well to low dose SRS (11.5-12 Gy) or SRT (25 Gy in 5 fractions) Slane et al., PMID 28089525 However, both of these approaches use a somewhat higher dose than the spinal cord tolerance doses. Therefore, I would treat the patient on a radiation delivery system equippe...
Would you offer any additional adjuvant therapy after platinum based chemotherapy for patients with resected PD-L1 positive Stage II-III lung adenocarcinoma with EGFR exon 20 insertions?
At this time, I would likely offer adjuvant immunotherapy as in KEYNOTE-091 NCT02504372 (pembrolizumab) or IMpower010 (atezolizumab). Though EGFR ex20ins mutations occur mainly in non-smoking patients with NSCLC, a population that tends to benefit less from immunotherapy, there is little data to sug...
Do you routinely prophylactically anticoagulate patients undergoing systemic chemotherapy outside of the perioperative period?
No, I don’t routinely advise prophylactic anticoagulation for outpatients with gynecologic malignancies while on systemic chemotherapy who have not recently undergone surgery. However, such treatment may be considered for gynecologic cancer patients who are at high risk for venous thromboembolic dis...
Do you routinely prophylactically anticoagulate patients undergoing systemic chemotherapy outside of the perioperative period?
No, I don’t routinely advise prophylactic anticoagulation for outpatients with gynecologic malignancies while on systemic chemotherapy who have not recently undergone surgery. However, such treatment may be considered for gynecologic cancer patients who are at high risk for venous thromboembolic dis...
Would you consider using tucatinib in a patient with de-novo metastatic HER2+ HR(-) breast cancer patient with extensive intraparenchymal and leptomeningeal carcinomatosis?
Absolutely. The HER2CLIMB regimen is well known to have good CNS penetration. There is an ongoing trial looking at this regimen in Her2+ leptomeningeal disease (TBCRC049). Given the pacity of studied regimens/data in leptomeningeal disease, this is an excellent option. Other options include T Dx'd -...
How do you manage patients blood pressures while on anti-angiogenic TKIs?
Advise patients to take BP daily, and inform us if the BP is high.
Should all patients with a remote history of immunotherapy, chemotherapy and/or radiation therapy have a baseline TTE regardless of ASCVD risk?
The current ASCVD risk assessment calculators we have available do not contain cancer-specific parameters and thus are inadequate for accurate assessment of a cancer survivor's risk of developing CHF and ischemic heart disease. If patients have received mediastinal radiation therapy or high-dose ant...
How would you manage a patient with stage IV EGFR L858R mutation but with a debilitating drug rash from osimertinib?
I'm assuming that all methods of supportive care and dose reduction have been tried at this point (i.e. even with maximal supportive care, Dermatology referral, and osimertinib reduced to 40 mg PO daily), there is still intolerable rash. This is a difficult situation and there isn't much available i...
During induction therapy for acute leukemia, when do you decide to discontinue the antimicrobial prophylaxis?
Antimicrobial prophylaxis (PPX) during treatment of acute leukemia can take several forms, and it is not always directly associated with blood counts.Fungal PPXDuring induction for AML, there are randomized data supporting posaconazole over fluconazole or itraconazole (Cornely, et al. New Engl J Med...
During induction therapy for acute leukemia, when do you decide to discontinue the antimicrobial prophylaxis?
Antimicrobial prophylaxis (PPX) during treatment of acute leukemia can take several forms, and it is not always directly associated with blood counts.Fungal PPXDuring induction for AML, there are randomized data supporting posaconazole over fluconazole or itraconazole (Cornely, et al. New Engl J Med...