Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
In a patient with unresectable, multifocal recurrent cutaneous squamous cell carcinoma and underlying T-cell large granular lymphocytic leukemia with baseline moderate pancytopenia, is anti-PD-1 therapy (e.g., cemiplimab) an appropriate and safe treatment option?
This is a complicated question! First, be sure of the diagnosis. The differential diagnosis is quite long. If it is something else that may or may not influence your decision. Second, if we agree that the lesions are not resectable, might they be treated with radiation therapy? This will not give th...
Do you recommend ovarian suppression in all premenopausal women under age 35 with ER positive breast cancer based on the SOFT/TEXT data, regardless of other risk features?
I do not recommend ovarian suppression on all women under 35. Like any intervention, we need to know the absolute risks of recurrence with and without the intervention. For these reasons, given the side effect profile of ovarian suppression in younger women, I usually reserve it for women with large...
Could patients with smIPI >1 and poor tolerability to R-CHOP be offered ISRT after 3 cycles of R-CHOP if interim PET showed 5-PS 1-3 response?
The revised NCCN guidelines largely reflect data from studies demonstrating excellent outcomes with four cycles of R-CHOP in patients with low-risk diffuse large B-cell lymphoma (DLBCL), including FLYER, LYSA/GOELAMS, SWOG S1001, and the most recent trial, LNH2009-1B. Although each of these trials e...
Could patients with smIPI >1 and poor tolerability to R-CHOP be offered ISRT after 3 cycles of R-CHOP if interim PET showed 5-PS 1-3 response?
The revised NCCN guidelines largely reflect data from studies demonstrating excellent outcomes with four cycles of R-CHOP in patients with low-risk diffuse large B-cell lymphoma (DLBCL), including FLYER, LYSA/GOELAMS, SWOG S1001, and the most recent trial, LNH2009-1B. Although each of these trials e...
For a patient with intracranial mets for ES-SCLC who undergoes resection, do you routinely offer post-op SRS to the cavity, or do you proceed with WBRT?
While Whole Brain Radiation Therapy (WBRT) has been the standard, stereotactic radiosurgery (SRS) to the surgical cavity is increasingly being used to minimize neurocognitive decline. However, the issue is especially more nuanced for an ES-SCLC (we don't know whether the primary has been controlled ...
What is the utility of a hypercoagulability workup in recurrent cryptogenic stroke, and what specific tests would you recommend?
Ambulatory monitoring for AFib is probably more helpful than such a thorough clotting workup.
For patients with locally advanced GEJ adenocarcinoma with low PDL-1 score, will you still incorporate durvalumab with FLOT therapy?
Yes. I would still incorporate durvalumab with FLOT in patients with locally advanced GEJ adenocarcinoma even when PD-L1 expression is low. MATTERHORN was intentionally designed as an all-comers study without PD-L1 selection, and the event-free survival benefit was observed in the overall population...
If using the triplet AMPLIFY regimen with ven/acala/obin upfront, what do you then plan to use in 2nd line treatment of CLL?
For patients who achieve a favorable response that lasts >1 year (or so, this is a ballpark estimate that may shift with more data), I would be very comfortable re-treating with a covalent BTKi (preferably after screening for BTK resistance mutations by NGS where available - with note of caution tha...
If using the triplet AMPLIFY regimen with ven/acala/obin upfront, what do you then plan to use in 2nd line treatment of CLL?
For patients who achieve a favorable response that lasts >1 year (or so, this is a ballpark estimate that may shift with more data), I would be very comfortable re-treating with a covalent BTKi (preferably after screening for BTK resistance mutations by NGS where available - with note of caution tha...
Do you get DEXA scans routinely before starting ADT for prostate cancer or endocrine therapy for breast cancer?
When initiating long-term ADT, I order a DEXA scan, check vitamin D level, ensure adequate dietary calcium intake, and discuss weight-bearing exercise/refer to PT when appropriate. I also continue check DEXAs every 2 years unless they otherwise meet criteria for a bone-modifying agent (mCRPC with bo...