Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How would treat a patient with good performance status with PTCL-NOS found to have leptomeningeal disease during treatment course with CHOEP?
I haven’t combined CHOEP with high dose methotrexate before! I have treated a patient with HIV-associated B-cell lymphoma with R-EPOCH and high dose methotrexate at D15 successfully with growth factor support. For patients with PTCL-NOS and leptomeningeal involvement at presentation, I would likely ...
What would your next line treatment be for a patient previously treated with repeat resection, craniospinal irradiation, and initial cisplatin/vincristine/CCNU with medulloblastoma?
As you will agree, this is an extremely unfortunate situation. I am assuming this patient has progressed either while on therapy or soon after completion? Depending on his age, a potential option is to enroll him on any available clinical trials. PBTC58 study uses intrathecal omburtumab along with c...
Would you still offer adjuvant osimertinib to patients who elect not to receive chemotherapy in resected EGFR mutated lung cancer?
Yes- while it is important to keep in mind that platinum-based adjuvant chemotherapy confers OS benefit in the appropriate setting, adjuvant chemotherapy prior to osimertinib/placebo randomization was not mandatory in the ADAURA study design. In the updated analysis presented at ESMO 2022 by Tsuboi ...
For Siewert 3 locally advanced GEJ adenocarcinoma, when do you offer preop chemoradiation (CROSS regimen) vs periop chemotherapy (MAGIC or FLOT)?
Siewert I/II GEJ adenocarcinomas are treated according to esophageal cancer algorithms, while Siewert III GEJ adenocarcinomas are treated according to gastric cancer algorithms. Consequently, perioperative chemotherapy with FLOT is the standard, evidence-based approach for fit patients with Siewert ...
How would you manage an older, frail ECOG 2 patient with stage II muscle-invasive bladder cancer with other competing risk of death?
Conceivably, treatment options are extremely limited for older, frail patients with localized muscle-invasive bladder cancer, who are not candidates for cystectomy or radiation. TURBT is a common practice in this patient population (Trulson et al., PMID 23817891), but without any improvement in outc...
How would you treat de novo MET amplified, RAS wt metastatic CRC after progression on standard first-line therapy?
I personally have used tepotinib or capmatinib (completely off label) and have had excellent results (n=2) and sustained response of ~9mo in one and ~12mo in another. Again, this is completely off label and it was after a very serious discussion and goals and outcomes. Both patients are very young, ...
How do you choose bridging therapy prior to CAR-T leukapheresis?
There is a lack of uniform clarity around terminology here. To avoid confusion, I prefer using "debulking" for treatment that is administered prior to T-cell apheresis, and "bridging" for treatment administered after apheresis to bridge the patient during manufacture to maintain disease control prio...
Do you use GCSF for a patient with MDS with excess blasts and neutropenia?
It really depends on what you are trying to achieve: If the goal is to get the patient to a curative allogeneic transplant, then the answer is no. If the goal is to get an elderly frail patient to break fever and leave the hospital to spend some quality time with family, then the answer is yes!
When the initial diagnosis of stage I uterine leiomyosarcoma is made via a non-intact resection such as a myomectomy or supracervical hysterectomy, what factors, if any, might push you to consider adjuvant chemotherapy after completion surgery?
Great question. Delivering a non-intact uterus has been investigated and reported over the past several years. Specifically, it has been reported in the context of uterine morcellation and the prognosis of those surgeries that morcellated sarcomas compared to those that the uterus was delivered inta...
What first-line therapies do you recommend for patients with folliculotropic mycosis fungoides?
Agree with Dr. @Dr. First Last as above. For first-line topical therapies for patients with limited skin disease, you can consider topical steroids or topical nitrogen mustard, although these agents may not penetrate the skin to a sufficient depth to treat the disease at the hair follicle. Other opt...