Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Do you switch from imatinib to another TKI in patients with chronic phase CML who develop renal insufficiency?
Imatinib has been associated with a decline in GFR. It is not certain (and probably doubtful) that this represents kidney damage. If no other causes can be identified, a change could be appropriate. Bosutinib has been associated with a similar decline so nilotinib or dasatinib might be better option...
How would the development of pneumonitis from pembrolizumab after treatment as per Keynote 522 alter your PMRT recommendations?
If recovered completely, I would proceed with PMRT.
When would you consider tapering glucocorticoids in a patient with ICI-associated myocarditis?
Once troponins start to decrease, I start the steroid taper and follow troponin levels. If they rise, I slow the taper. I also get serial ECGs, esp if there were arrhythmia manifestations of myocarditis. Don't forget to assess for the need for PJP prophylaxis with Bactrim or pentamidine and PPI sinc...
Do you always obtain PSMA PET as initial staging for high risk and very high risk localized prostate cancer patients?
I do obtain a PSMA PET/CT or PET/MRI in all patients with high risk localized prostate cancer. However, when this is not available due to insurance coverage issues or lack of access to PSMA PET, it is still acceptable to stage with bone scan and CT or MRI. I prefer PSMA PET because it has better per...
Would you consider using Breast Cancer Index to make decisions about extending AI therapy in patients who completed 5 years of AI, given recent data presented at SABCS 2022 about validation of BCI in IDEAL trial?
Use routinely.
Do you change treatment for confirmed biochemical progression in patients with otherwise secretory MM even if the M-spike is <0.5 g/dL?
I agree- these decisions should be individualized. However, the reason I posted this comment is to draw attention to the problem which hematologists and oncologists have all but ignored - a huge problem with overtreatment. 30%+ what we do is unnecessary and quite likely harmful. We are not short on ...
In small cell lung cancer with effusion that is negative on thoracentesis twice, do you assume limited stage disease?
Although we know the sensitivity of a single thoracentesis to detect malignant pleural effusion is fairly low (perhaps 65%), effusions in SCLC can sometimes be reactive - if there is any lung collapse, for example. If otherwise limited stage and multiple attempts have been made to rule out malignant...
In the Nebraska/Mayo transplant protocol for perihilar cholangiocarcinoma, do you ever offer prophylactic biliary drainage/stenting to prevent obstruction post-chemoradiation?
We use an ERCP-placed nasobiliary approach to biliary brachytherapy as part of our pre-transplant CRT regimen for patients with peri-hilar cholangiocarcinoma (Murad et al., PMID 22504095). Our technique is described by Deufel et al., PMID 29776892. Patients with baseline tumor and/or comorbid diseas...
Do you check beta 2 microglobulin in patients with MGUS?
I think this question can be answered in two ways - firstly, from the vantage point of clinical utility, and secondly, from the vantage point of cost-effectiveness. I think the short answer to both is no. For patients with suspected smoldering MM awaiting bone marrow biopsy, PET-CT, wbMRI, etc. I ...
Do you always start treatment for patients who meet diagnostic criteria for multiple myeloma by SLiM criteria alone?
No, I definitely do not always start treatment for patients who meet the so-called myeloma defining events. These are guidelines, like the Pirate Code. Sixty percent plasma cells mean reaching CRAB criteria in 2 years in 95% of patients, greater than one 5 mm MRI abnormality means CRAB criteria in 7...