Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Is there a role for chemotherapy for asymptomatic Well-Differentiated Papillary Mesothelioma or Multicystic mesothelioma?
No role for chemotherapy, in my opinion. These presentations should be handled by observation if asymptomatic, or surgery when symptoms start to appear. Treatment should be debulking with or without hyperthermic perfusion with local chemotherapy.There are many case reports of chemotherapy treatments...
What is the optimal dosing schedule and duration of zoledronic acid in breast cancer patients with bone metastases?
The short answer is YES, a monthly schedule x 1 year, followed by a dose every 3 months seems to be a reasonable standard of care. However, additional research is needed to answer the question about optimal duration of therapy and dose/schedule in years beyond the first two years of therapy.
How do you utilize immunoglobulin testing to affect treatment decisions in patients with myeloma?
Most of the time, I correlate the type of Ig the patient has with the serum M protein and Free light chain to see if they are responding or progressing (most of the time it will correlate); the only exception is patients who are known with IgA type; most of the time the serum M -protein might not co...
How do you utilize immunoglobulin testing to affect treatment decisions in patients with myeloma?
Most of the time, I correlate the type of Ig the patient has with the serum M protein and Free light chain to see if they are responding or progressing (most of the time it will correlate); the only exception is patients who are known with IgA type; most of the time the serum M -protein might not co...
How do you approach a young patient with undifferentiated pleomorphic sarcoma of the upper extremity who developed ifosfamide-induced nephrotoxicity after two cycles of adjuvant AIM chemotherapy?
In the adjuvant setting, I would suggest to stop further therapy and observe the patient. There is no clear survival benefit with the use of adjuvant therapy. However, I do say this with the knowledge that Sarculator-based analysis of EORTC-STBSG 62931 has demonstrated an OS benefit in patients rece...
Are durva/cis/gem or pembro/cis/gem less efficacious in cholangiocarcinomas with FGFR2 fusions?
I have not been able to find an answer to this question. The NCCN and French National Clinical Practice Guidelines both continue to recommend first line treatment with Gemcitabine/Cisplatin and Durvalumab. Exceptions include NTRK gene fusions and MSI-H/dMMR where NTRK inhibitors (e.g. entrectinib, l...
Do the results of CheckMate 451 (nivo-ipi or nivo maintenance after chemotherapy in patients with SCLC) raise any questions for you about the role of immunotherapy in SCLC as established by the CASPIAN and IMpower 133 trials?
The results of the Checkmate 451 trial evaluating nivolumab and ipilimumab or nivolumab maintenance versus no maintenance following front line chemotherapy for extensive stage small cell lung cancer help put the CASPIAN and IMpower 133 trials using front line chemotherapy with immune checkpoint inhi...
Do you get routine MRI brain for surveillance on patients with history of stage III melanoma?
Unfortunately, this is an area that doesn't have a lot of data to support recommendations. It is rare to develop CNS/brain metastasis as the only site of metastatic disease (~5% of metastatic patients). Therefore, I try to get an annual MRI brain for stage IIIB-IIID (resected) patients, especially i...
How do you manage steroid-refractory acute GVHD following allogeneic transplant?
The short answer is to enroll the patient in a well-designed clinical trial, if available. If not, I would start with ruxolitinib based on the REACH2 trial (Zeiser et al., PMID 32320566) which was multicenter, randomized, open-label, phase 3 trial comparing the efficacy and safety of oral ruxolitini...
How do you manage steroid-refractory acute GVHD following allogeneic transplant?
The short answer is to enroll the patient in a well-designed clinical trial, if available. If not, I would start with ruxolitinib based on the REACH2 trial (Zeiser et al., PMID 32320566) which was multicenter, randomized, open-label, phase 3 trial comparing the efficacy and safety of oral ruxolitini...