Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Is there a role for phlebotomy in secondary polycythemia?
Prefatory to answering the question, I think it's important to specify the full nature of the problem because there is confusion in the hematology literature about the criterion used to define erythrocytosis as well as the phlebotomy target in secondary erythrocytosis. Currently, hematologists use t...
Is there a role for phlebotomy in secondary polycythemia?
Prefatory to answering the question, I think it's important to specify the full nature of the problem because there is confusion in the hematology literature about the criterion used to define erythrocytosis as well as the phlebotomy target in secondary erythrocytosis. Currently, hematologists use t...
Do you offer iron supplementation to a patient with iron studies that are normal (including normal ferritin) except for low iron saturation?
The answer is absolutely and positively yes. A low percent saturation of transferrin has an extremely high concordance with absent marrow hemosiderin and frankly, in today’s parlance is the best indicator of “iron need”. While the ferritin is marvelous at confirming iron deficiency if low (with or w...
Are there any scenarios in which you would consider use of PARPi in the upfront mCSPC setting rather than reserving for CRPC?
The FDA approved talazoparib plus enzalutamide for HRRm metastatic CRPC in June 2023. NCCN panel recommends talazoparib plus enzalutamide as a category 1 treatment option for patients with metastatic CRPC and a pathogenic mutation (germline and/or somatic) in one of certain HRR and other DNA repair ...
Would you treat a patient with cT2 ER+/HER2+ breast cancer with neoadjuvant HER2 directed therapy if HER2 positivity is group 3?
If the case remains group 3 after an independent retesting with FISH and IHC as recommended by ASCO CAP guidelines, then the official recommendation is to treat it as HER2+ and use anti HER2 neoadjuvant therapy. However, some of these tumors are more luminal B than HER2 enriched on gene expression t...
In patients with recurrent advanced ovarian carcinoma and a hypersensitivity reaction to platinum, do you prefer a desensitization protocol to maximize response or switching to a non-platinum regimen?
If the patient is platinum sensitive, I would do platinum desensitization. we have very good protocols for successful desensitization.
What is your preferred conditioning regimen for fit patients with high-risk MDS undergoing MUD allogeneic stem cell transplantation?
The short answer is whatever MAC regimen you and your center are familiar with and comfortable managing the side effects. I would definitely think of a myeloablative regimen rather than a reduced intensity one. For HLA-matched donor, I usually give MAC Bu4Flu with Bu PK to tailor the Bu dose. The BM...
What is your treatment approach in patients with early breast cancer with axillary soft tissue involvement, with or without concurrent lymph node involvement?
We are fortunate that Mass General has recently published an excellent paper on this topic that helps give guidance (Naoum et al., PMID 37967296). As expected, axillary soft tissue involvement is a high-risk feature, and these patients are at high risk for metastatic disease. For example, if there i...
What FGFR inhibitor would you use for a patient with cholangiocarcinoma and a FGFR3 mutation?
Honestly, the response to these inhibitors with FGFR alterations beyond FGFR2 fusions is quite low in the data known to date. The initial infigratinib study had responses primarily in the fusions. Similar outcomes were seen in the first study with pemigatinib (Abou-Alfa et al., PMID 32203698). There...
What is your approach to cT3N0M0 mid rectal adenocarcinoma with clear circumferential resection margins on MRI?
This is an important issue in management of rectal cancers. It is best handled with an informed discussion and decision by the patients considering the pros and cons of initial surgery versus neoadjuvant therapy. The problem is, of course, inaccuracy of pretreatment staging, with the false negative ...