Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How do you approach hormone replacement therapy for premenopausal patients following pelvic radiation therapy?
Most patients who undergo pelvic radiation will become menopausal. Physiologically, the outcome is similar to surgical menopause because sufficient doses of radiation result in complete loss of ovarian function. In contrast, after natural menopause, the ovaries continue some types of endocrine funct...
What is the role of local control +/- whole lung irradiation in a patient with relapsed/refractory Ewing sarcoma to the hilum plus multiple lung nodules?
I would boost residual thoracic disease to at least the usual Ewings gross disease dose of 55.8 (total, including WLI dose). Doses in this range are well known to be safe in the thorax and this multiply relapsed disease is likely to be more treatment refractory than primary disease. SBRT boost seems...
Is there any reason to hold fulvestrant during SBRT to an oligoprogressive nodule?
No.
Do you offer IVIG to myeloma patients with recurrent infections?
I do offer IVIG to patients with myeloma who are having recurrent respiratory infections and have hypogammaglobulinemia (<400 mg/dL). I do counsel patients that we do not have strong clinical trial data to support the use of IVIG in this setting. While I dislike quoting anecdotal experience, I will ...
How would you approach the adjuvant management of thoracic SMARCA4-deficient undifferentiated tumor of the lung following lobectomy?
We know these tumors behave aggressively, but don't have a good handle on chemo-sensitivity. Some morphologically look like a sarcoma, and some others, carcinomas. Given the lack of clarity, if completely resected with negative margins, reasonable to watch closely and treat with measurable/evaluable...
How would you treat lymphoplasmacytic lymphoma (LPL) with a non-IgM paraprotein?
My treatment approach would be similar to those with IgM LPL (WM).
What's the role of ibrutinib and venetoclax in CLL in light of data emerging from ASH 2022?
Authored by @Dr. First Last and @Dr. First Last The current FDA-approved, standard-of-care for frontline chronic lymphocytic leukemia (CLL) therapy includes continuous therapy with a Bruton tyrosine kinase inhibitor (BTKi) such as ibrutinib or acalabrutinib, with or without an anti-CD20 antibody, or...
When, if ever, would you consider deep venous thrombosis prophylaxis for patients with advanced epithelial ovarian cancer undergoing neoadjuvant chemotherapy?
The Khorana scoring system is a great tool when this question comes up. I use it for all my ovarian cancer patients who have measurable disease in the neoadjuvant and adjuvant settings. I re-evaluate their score every 3 months to ensure they are still candidates for VTE ppx. Mulder et al., PMID 3060...
What's your choice of next line therapy for a metastatic papillary RCC who has progressed on cabozantinib?
Combination immunotherapy works well.
What are the current timing recommendations for initiating radiation after lumpectomy?
For me, this is dependent on the RT technique and plans for chemotherapy. If planning partial breast (regardless of plan for chemotherapy), I will recommend the RT prior to chemotherapy. I will usually simulate 3-4 weeks post-op and then start RT a week later. If planning whole breast, if no plan f...